1981, 02-20 Permit: 81A-1689 ResidenceIPLAN NUMBER
,r?
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
V/
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. j.g7Ji / =
LOT BLOCK
2. 3
OWNER
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIVISION
s'n 041)A -«'s A-00
3 :h'd-R alevsT cc, •
ADDRESS
'47 .i 'x
4.
CONTRACTOR
ADDRESS
DESIGNER
5. ADDRJSS
PHONE
922 36/0
IP
C'//f
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
/
North qt`'South f G East �' West
Size
Size of Parcel
9e; x .22e,
•
Zone Classification
ZIP
Type Cpnsl
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Floors Garage Area
2-
Finished Basement Unfin. Basement
a?'e
Upper
CHANGE OF USE FROM
6.
TO
Area of Decks
0
Storage
TYPE
7. OF
WORK
ANEW ❑ ALT.
BLD. ❑ PLMB.
❑ AD'N.
O MECH.
❑ RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
7
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd. Not Req'd.
DESCRIBE WORK
8. cd/Y.5. .5/A/
VALUATION
9.
Enum. Dist.
A'," (J. Grtk4C. r c/Nvc/l
ILocation (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
/G
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 —I3 8/ SIGNATURE OF APPLICAN
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Acirceee ,//
Fire Marshall
Co. En
�aK
Plans Examiner
B(y. I�d�ingJT//�hniciiaarn
PERMIT IS NONTRANSFERABLE
DCQIIAIT CYDIRFS (IMF VFAR FPr1M f)ATF OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
n
TOTAL $2-164
02* *28600
*28600 ti
*286006
N *0.00 g
1438g.
02-13-81
z 6/179.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02"20-81
11ATF ISSI IFn
168,92 *286.0021:1
PERMIT IVl
TOTa1