1981, 12-17 Permit: 81B-2827 DamperPLAN NUMBER APPLICATION/ PERMIT PERMIT NUMBER
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
1. 0 /o5,"a/ �d
I r1T RI r1CK Sl1Rn1V1. InN PARCEL NumKFR/S. i
OWNER
PHONE
3. 00 c C r%
91 ale —3 `/d• 7
ADDRESS
ZIP
Actual Set Backs in Feet
/o `?,A
5>,--4R e',, 6
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
¢11 aka„� r f�� 1` /�- �_
Va if -,Z /u o
4. ADDRESS /
ZIP
Type Const.
Occupancy
Sprinklered
❑No ❑
G 12 7/o /jet%: F ,✓st
gsIp1116
Dyes 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 1:1 ALT. El AD'N. ❑ RPL. ❑ MVE.
7, OF 10OTHER
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
DESCRIBE WORK Enum. Dist. I Location (Area)
8. ,y,/-- ,/ /-�a e Day G� / S' FW � a r e FEES COLLECTED
VALUATION SOURCE AS ELECTRIC WATER SEWER Ownership USE CODE
OF Public El Private ❑
9. UTILITIES
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 °2 SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
.�
nv. Health f `7
anning
Co. Engineer
Utilities
Plans Examiner
n PERMIT IS NONTRANSFERABLE
/X PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Single $
Building
Plumbing
Mech. 141,
Z9 -A- 11 A ,mac'.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTA L $ f % GV
li4* *14.00
xi -00
* 1 k 0 0
A
282 6
1 �17-F1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.21'j=81' 282723
DATE ISSUED PERMIT NO.
*1400 RE h- -
TOTAL