1981, 12-17 Permit: 81B-2823 DamperNUMBER 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
_ LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUBDIVISION PARCEL NUM ER/S
2.
OWNER PHONE /
3.
ADDRESS/
jam"'-
ZI /7
Actual Set Backs in Feet
%/f J�
V
North South East
West
CONTRACTOR
PHONE
Size of Parcel Zone Classification
• �°a " eC-rc �-�t-
9 i ' /O O
4' ADDRESS
ZIP
Type ConT,t.
Occupancy
Sprinklered
%tJ t✓ �� —
Oyes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
No. Baths
No. Stories
No. Rooms
No. of Dwellings
TYPE ❑ NEW 11 ALT. 1:1 AD'N. El RPL. ❑ MVE.
7, OF ❑ OTHER
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
DESCRIBE WORK
Enum. Dist. Location (Area)
FEES COLLECTED
8.
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
I UTILOITIES
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
DATE OF APPLICATION r �5 SIGNATURE OF APPLICANT`
Mech.
���/�"�
SPECIAL APPROVALS
SPECIAL CONDITIONS:
Plan (�
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
nlcian PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
SEPA
Mobile Home
Other (Specify)
TOTAL $ /I/. /--
PERMIT NUMBER
P, *1400
282'.1 -24
1 2-17-8 1
1479
�4* *1400 _
14.1'0 m
*140061
A *Ci0
21822
12-17-81
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
121-r1i7`�-8'1 2 8 23'z
DATE ISSUED PERMIT NO.
*1400° -
TOTAL