1982, 10-05 Permit App: 82A-9116 InsertSPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON/ SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
O
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
Mobile Home
Other (Specify)
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0 4 * * 2 0' 0 0
LOT
BLOCK
PARCI-r_ NVnnMR/S
2.
ISUBDIVISION
I
*20,00
n * 0 0 0
OWNER
��`
PHONE
3. i v0�vi. l --'� , ^T/AR C�
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ti
9 1 1.5 z
ADDRESS
ZIP
Actual Set Backs in Feet
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Z�
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North South East West
C p
1 0-0 J — V L
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4'
u 4 7 9.
6479.
ADD 5
ZIP
Type Const.
Occupancy
Sprinklered
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❑Yes ❑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.
TYPENEW ❑ ALT . ❑ DIN. ❑ RPL. ❑ MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwellings
7, OF 1-1OTHER
CERTIFICATE
Req'd.
I Recd.
Not Req'd.
WORK 1:1 BLD. ❑ PLMB. [[[ MECH. 1:1M.H. ❑ POOL
of EXEMPTION
DESCRIBE WORK
Enum. Dist. Location (Area)
8 ; `� i2
FEES COLLECTED
VALUATION SOURCE GAS ELECTRICE��WER Ownership USE CODE
OF
9. UTILITIES Public ❑ Private ❑
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
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
, + `��^��l
DATE OF APPLICATIO SIGNATURE OF APPLICANT Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Utilities
Plans Examiner
SEPA Checklist
g echnician PERMIT IS NONTRANSFERABLE
?2 PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
TOTAL $-'
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-05-82 911.625
DATE ISSUED PERMIT NO.
*20.00(OL FJ,
TOTAL
2
SEPA
O
Planning
Mobile Home
Other (Specify)
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Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
g echnician PERMIT IS NONTRANSFERABLE
?2 PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
TOTAL $-'
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-05-82 911.625
DATE ISSUED PERMIT NO.
*20.00(OL FJ,
TOTAL