1982, 10-07 Permit: M82A-9220 StovePLAN NUMBER
APPLI&TION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
JOB ADDRESS
c17o5 /0 -TN
LOT LOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
.1ct+Alz,P M Po LmJE
ADDRESS
`1705 Jo n4
PHONE
22.-33G6
ZIP
992.LY0
Actual Set Backs in Feet
North 'South East 'West
4.
CONTRACTOR
PHONE
Size of Parcel Zone Classification
ADDRESS
ZI P
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
L -IgEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. C .-MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. W00712 5 -To 11: S iJ
VALUATION
9.
SOURCE
OF
UTILITIES
GA, 7
S ELECTRIC
Enum, Dist, 'Location (Area)
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby 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
/O— -7— t2._
SIGNATURE OF APPLICAN
Zia
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
(SSUo
Other (Specify) i° fiK
TOTAL $ .ZOC_C�,
PERMIT NUMBER
04* *20,00
*20,00 b5
*20,006
*000
921,9-
10-07-82
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-07-82 922,02 *2O,OOa�
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE nATF 'SRI IFn
PFRIVIIT r\I/l TnTJI
t