1981, 12-16 Permit: 81B-2769 InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
k-/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
F7-VR—CEL
EGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDI ISION NUMBER/S
OWNER
3 i�[P Q (V
ADDRESS
CONTRACTOR
1'06 1"
PHONE
ZIP Actual Set Backs in Feet
` -9� o 6 North South East
PHONE Size of Parcel Zone Cla
V,P 3 -/0 / -,;7
ADDRESS
L/ C,tf
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes
SEPA Checklist
❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor
I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
I
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwellings
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. 10MECH. ❑ M.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
of EXEMPTION
I
DESCRIBE WORK
8.
Enum. Dist. I Location (Area)
FEES COLLECTED
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9. Q
UTILITIES
Public ❑ Private ❑
Single $
1 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
Building
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE/ SIDE FOR REQUIRED INSPECTIONS
Plumbing
REVERSE
DATE OF APPLICATION 7< SIGNATURE OF ADPLICA
ec .
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Env. Health
Planning SEPA
Fire Marshall --
Mobile Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT NUMBER
.M �" l-6`7
04* * 1 7.00
*1700
* 1 7.00
A *0.00
276R_
12-16-81
6.479,
E,
eyu @chn n PERMIT IS NONTRANSFERABLE 127A, 6 - 8'' 1O J -
276,9zd *17.00a�-
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL