1982, 03-10 Permit: 82A-1697 Fire Damage RepairPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — B'U'ILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. F 12_ 27,-.) < f
LOT BLOCK
t 1
2.
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNS i I N
3.
ADDRESS
'J
6 I ')-iz 0o
CONTRA TO
Ivy
4' ADDRESS
R
PHOfyE
ZIP
i72'c' 6
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East
West
Size of Parcel I Zone Classification
ZIP
Type C nst.
\ N
Occupancy
Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NAW Er/ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not F3*q
DESCRIBE WORK
8.
8 VA )IITIJN SOURCE GAS
9. I i
UTILITIES
Enum. Dist.
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private
Location (Area)
1
/ USE CODE
I here'by certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION ft-SIGNATUREOF APPLICANT k � • /"'' `eY.
SPECIAL APPROVALS
NAME DATE
Env. Health
twri IJ -
Plann ng
Fire Marshall
Co. Engineer
Utilities
Pla.nls
'Exaamineerrr
EPA`Ceck
S
st
Buildin Te ni
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Vlech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ !c
PERMIT NUMBER
?
02* *10800
*10800 1-6
*108006
A *000 n
169.6g
03-10-82
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0-'3-10-82 169,7 *108,002 -
DATE ISSUED PERMIT NO. TOTAL