1981, 09-02 Permit: 81A-8827 DemoPLAN NUMBER
APPLICATION/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
JOB ADDRESS
1.
LOT
2.51‘.
OWNER
3. i eal:or.)
ADDRESS
E, tCaht`1
CONTRACTOR
same
ADDRESS
SAMC
DESIGNER
,GCqOG, tb114
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
t5 -
SUBDIVISION
LAU%) Q..e; IT-/ CrAce
4.
5.
PHONE
<ac..i_, on A ►ti.
PARCEL NUMBER/S
ZI P
tri CN
Actual Set Backs in Feet
North
South (East
PHONE
Size of Parcel
11Cxi5u
'West
Zone Classification
PSG. 6uz3O R- AAJ
ZIP
Type Const. Occupancy
SCiL t2 )
Sprinklered
Oyes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
Co CO
ADDRESS
ZIP
Main Floor
vv
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
❑NEW ❑ ALT.
5%BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not yeq'd.
DESCRIBE WORK
VALUATION SOURCE
OF
9. -0-- UTILITIES
Enum. Dist.
'Location (Area)
GAS
ELECTRIC
WATER SEWER
Ownership
Public ❑ Private N/
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 APPLICATIOgJ Sey / 2) SIGNATURE OF APPLICANT71�% Z) %'�r✓1,41art
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building
echnician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single �'$L$
Building `� 10,.20
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ iii4CX
PERMIT NUMBER
02* *1000
* 1 0.00 V)
88262
09-02-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09,-0Z-81
DATE ISSUED
882,72 *10.0Oa(-
TOTAL
PERMIT NO.