1982, 01-22 Permit: 82A-605 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
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SPOKANE COUNTY — BUILDING CODES DEPARTMENT ' ` � � 400'NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES ` u 2 ,,
JOB ADDRESS I
L
1. I ! 2_2_. UBLEGA
DESCRIPTION — SEE ATTACHED
LOT
SUBDIVISION PARCEL NUMBER/S * G o'"
Q �.7 0 V
2. 0,pM PHS �7 hn00
ADDRESS _ ZIP Required Set Backs in Feet C1 L' r,
21�2— i✓ • t , • rA�� 1 1 North 'South East West =' 1 — 2. 2 — P-2
ffCONTRACTOR PHONE Size of Parcel Zone Classification
4. C ,�� 6I-1 II FLIM 442 ' ?573 a.4 7 9
ADDRESS
� �� DI ����'� D `!� zlr,�-,L-<-� Type Const. Occupancy Sprinkle red
N. ( E5
❑Yes ❑No ❑ Req'd.
DESIGNER 1 PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No.Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF LI OTHER
WORK CIBLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. t K\
Kt
-M J,'' Ct��,AGn 1 f�•ter FEES COLLECTED
VALUATION Source •�GAS ELECTRIC WATER SEWER
of
9. Utilities
Single $
—
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 Building
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.
DATE IPlumbing
ii�i (~ I •
SIGNATURE�_� �j \�� �— Mech. 21:-)SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
o=
SEPA c)
Planning _ w
2
Mobile Home on
Fire Marshall
Co. Engineer Other (Specify)
Utilities \�
TOTAL $ (�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checkl ist / THI CO S A p !MIT. (' [
DATE L/`cDF✓FICI �.'.----------)....„ (LUnt.............9 �� 18 U Q.l 2 * 2 O. 0 0. I-
APPROVR ISSUANCE