1981, 09-17 Permit: 81A-9475 ResidencePLAN NUMBER
t
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
1.
2.
3.
JOB ADDRESS
E_, /061. TH AVE,
LEGAL DESCRIPTION — SEE ATTACHED
LOT
3
BLOCK
1
SUBDIVISION n A ,t
PHONE
OWN
v 1 w • ROI -I-%
ADDRESSEl i0G r2- '
PARCEL NUMBER/S
D S tLf! leo?
4. ADDRESS
RAC OR
PHONE
ZIP
Actual Set Balks in Feet
i
�1 r
North q3 ISouth 5d East 'Westf2 d
Size of Parcel „. Zone Classification
/0 a 1-0 Acg l c:.0 i_ Tu,i� L. - S U B
Type Const.
ccup cy
Sprinklered
DYes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
ZI P
Do
MainjFlgor�. Upper Floors Gar urea
Building Area inSc} Ft.
r79
CHANGE OF USE FROM
6.
TO
Area Of DQcyCs
Finished Basement
Storage
115 Unf�
Base
7.
TYPE
OF
WORK
,IlS N E W ❑ ALT.
lj{� BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Roams
No. of 7wellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. , � i�'N on )1 rc fide-., 5,
LUAT ON SOURCE GAS ELECTRIC
OF
9.ks7 22S- (0 UTILLITIES
et raCe e
‘NATE-'1
SEWER
num. Dist.
Location (Area)
Ownership USE CODE
Public ❑ Privatepri
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
type of work will be complied with whether specified herein or not. The granting
to give authority to violate or cancel the provisions of any other state or local law
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIOJ
DATE OF APPLICATION
11
SIGNATURE OF APPLICANT
and ordinances governing this
of a permit does not presume
regulating construction or the
W
SPECIAL APPROVALS
NAME DATE
ealt
Planning
Os—
Fire Marshall
Co. Engineer
-Utilities���
cc ((cf
Plans Examiner
--tom O.S-1 /441T X120'3
SEPA Checklist
Buildin Technician
,;
SPECIAL CONDITIONS:
aN MA-r.�CiWW
t1/3/P/
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$
ofl
3o7 Xx
Do
TOTAL $ 3c)7 Xi"
PERIy(rT-NUM• EP
V6\ "-
02*
02* *307.00
*30700
*307006
A *0.00 0
931.22
09•-14-81
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Oga-1�1t-8 1
DATE ISSUED
4�a,
PERMIT9NIJ 5 z
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