1981, 03-03 Permit App: 81A-2012 ResidencePLAN NUMBER e - •
/f- BMA -67
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
44
1. 2-
LOT BLOCK
2.
•
osPAls,1
SUBDIVI ION
3.
OWNER ,
as
6,612,riJ
ADDRESS
4.
CONT CTOR
ADDRESS
HONE `!__
ZIP
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S�' I� �553
PO Cr N, Il0, 4� or �,
or Lo -T I'�, L'oOK 17 G�74o-,
Actual Backs fn Feet („
North 'South 1'2—LEast .3 'West
DESIGNER
5' ADDRESS
ZIP
PHONE
Size of Parcel
rr X 1 0
Occupi ncy
Typo Cronst.
Valuation
f? 000
Zone Classification
Sprinklered
❑Yes No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
6.
CHANGE OF USE FROM
TO
Main Floor 1' Upper Floors IIr jet t.ea
1"'(o serw
Finished Basement"'
Area of Decks
elrage
TYPE
7, OF
WORK
❑ ALT. ❑ AD'N. ❑ RPL.
LJ BLD. VPLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ OTHER
❑ POOL
No. Baths
No. Stories
No. Rooms
Unfin. Basement
1176
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not. Req'd.
8.
DESCRIBE WOIRK
VALUATION SOURCE GAS LECTRIC
OF
9 Llj{U_ 6�&3;--
UTILITIES
Enum. Dist. 'Location (Area)
WATER
471,jraCjV�
SEWER
hereby certify that I have read and examined this application and have atl 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 ( 9Y7SIGNATURE OF APPLICANT ` ti' t'dt C
Ownership
Public 0 Private ire
USE CODE
SPECIAL APPROVALS
NAVE DATE
nv. ea
6113/2
Planning
Fire Marshall
C E g er
3/0Vgi
Utiii ies
Plans Examiner
ail pOS- W,j7 3)3 )
SEPA Checklist
•pian
SPECIAL CONDITIONS:
Ov )1(-- ti4)01
Ht+aNA J,»3/ A4411sthit
I i�•I,�.�1I a2x. jk �e r, �,� xJ, J 3I
I\4101 01A16a
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
tcf
FEES COLLECTED
1
Single $
Building !�' n
e'
Plumbing
Mech.
Plan Check
SEPA
�jG I
M..L�ilcLFlome °C7
Other (Specify)
TOTAL �044,I,6o
✓f ...gyp
PERMI I FUMBER
SIN-Zo>t2
02* *8000
*8000
*8Q006
A *000 8
193.42
03-02-81
z 6479,
03* *21,00
*21.00 N
19352
03=p2-81
2 6479.
07* *10000
*100,00 N
19362
03-02-81
z 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05'41)1 78
DATE ISSUED
20122 *201:000 -
PERMIT NO. TOTAL
175'
bh i
a5
�`\� 5. .6' n� Ki . IG9, 45, CP N . l ,21
9 '
or- L; f 172 p, q [1 , ce,r-,il I N A10. '0,6114a
Pic. zcAO
•