1982, 05-18 Permit: 82A-3896 MH PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT " 35%
elNORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS C, r * * 1 5 4 0 0
1. E• �ta,t �5 i 5 rN I�yiE LEGAL DESCRIPTION - SEE ATTACHED
I :_ C' C% J)
LOT BLOCK SUBDIVISION PARCEL NUMBER/S 24.533 ._OG2.I
2. 5 'i- 'tiAu.gY r)rew' t-iit.Ls SE-coNp PON-6W
* 1 5 A 00
OWNER PHONE
PHONE !"i * C i; ,`, P3 ADDRESS STA 4LI' O~AUtZ P S-2.08 Actual Set Backs in Feet
36 sp<Q/SCALL (19262-262- North (South 5O East /C I W e s t /0
CONTRACTOR PHONE Size of Parcel Zone Classification ( 5— 1 3- 8 2
a. Bhg.NE-TT c:oNsTP iAcriON Z-92.-z336 5a 'x -Zoo 12.4g4 A4Prc.ULNR cud 1 l< 7 S
ADDRESS ZIP Type Const. Occupanky Sprinklered
AT ) ,.), ' GrCi'009 V---N Q.3 ❑Yes ❑No 0 Req'd.
DESIGNER PHONE Va)uation Building Area in Sq. Ft.
5. sots- ...Ag CAPE MA VIF>ACTi4R it y� ZZ ri
ADDRESS ZIP Main Floor Upper Floors Garage Area Storage _
P0- 83s� �rs )f) 8370? rosy -- 5-72.. —
CHANGE OF USE FROM TO f Area of Decks Finished Basement Unfin. Basement
6. ,-- --
TYPE ,/ No. Baths No. Stories No. Rooms No. of Dwellings
IS NEW 0 ALT. ❑ AD'N. 0 RPL. ❑ MVE. .2+ ar I 5--
7, OF 0 OTHER
WORK ®BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION L--'
DESCRIBE WORK Enum, Dist. !Location (Area) 1
8. M/JUF'i;K{L -D Nofa- 004 FpUNGrfuot•A FEES COLLECTED
I
VALUATION SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
9, UTILLITIES _� Public 0 Private 0
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included op -
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building 54-*
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 Plumbing
Plumbing
DATE OF APPLICATIONS ` /`Q /9 SIGNATURE OF APPLICANT( Y"""� Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: Plan Check
NAME DATE CRMJL sPA . if 2.00 1�,5so x Z 33:0
Env. Health ON � 2
"moi 7� SEPA
Planning
Mobile Home LU
Fire Marshall
Q 1
Co. Engineer _ Other(Specify) /OO )(
Ai", ii2rr). (. J.:;,-
Utilities
tUtIIItIeS
TOTAL $
P s Examin r
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA hecklist THIS BECOMES A PERMIT.
Building Technician PERMIT IS NONTRANSFERABLE o ,-,:a: 8 :8;2 3 8 Q,6 z *1 5 4.U.O
-/Erw /-225e- T PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
Certificate of Insurance
acord THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
NAME AND ADDRESS OF AGENCY
COMPANIES AFFORDING COVERAGES •
F. W. Hanson Agency, Inc.
Wilbur, WA 99105 COMPANY A Safeco
COMPANY B
LETTER
NAME AND ADDRESS OF INSURED
COMPANY
LETTER
•
Robert L. Sewall COMPANY
Harrington, WA 99134 LETTER
COMPANY E
LETTER
u
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement,term or condition
of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to ali the
terms,exclusions and conditions of such policies.
Limits of Liability in Thousands(000)
TYF-['LFINSURANCE POLICYNUMOCC JRRENCE
LETTER LXFiRATION LATE t
EACH it--
( HEL E�
GENERAL LIABILITY —
hob'_v INJURY 000,000 000,000
I COMPRENEN$NE FORf✓1
1--E.' PREMISES--OPERA IONS CP427449A 7-9-82 PROPER;Y DAMAGE : 000,000 1300,000
LYPLGTION AND ,OLLAPSE
, 1 HAZARD i
l:i UNDERGROUND HAZARD
IFE PRODUCTS'COMrI_ETEC
OPEP�EIONS HAZARD i BODILY INJURY AND
11E CON,R CTUAL INSURANCE _ I PROPERTY DAMAGE $ $ 1
BROAD FORM PROrERI COMBINED
i Ln r' DAMAGE
1 LJ INDEPFNDEM CONTE :C LOBS . 7 ----.--a
PERSONAL INJURY • j $ 1
PERSONAL ;N)La; 300,000
AUTOMOBILE LIABILITY NI iL, NJURY -
,EA1.00,000
t F msoN
If COMPRE+E YSNF rORM • CP427449A 7-9-82 BODILY INJURY $
D OWNED
A(,UDENTI 300 000
❑ HIRED PROPEPTA DAMAGE $ 25,000
JY I BOOBl INJUR.r AND
NEJ
El NON- PROPf RrY DAMAGE I $
COMBINED
EXCESS LIABILITY II N_I A ;ND
J
UMBFr t ;RAA iPOPf - LAM ALOE , $ $
0 C TREK I HA',.'.:MF3PfLI_A
FORM
---- WORKEF S'COMPENSA T tON..
n.
EMPLOYER I.tABI_I: r
OTNEP ,
•
Blastin7. for water Line on filth street in West Electric City, T1i.
ay Lr l9„2
,
CfTO:.l ne Count;,? .
nellrty.,rnt of :9:1111,-.11n:,: Safety
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