1982, 05-25 Permit 82A-4179 AdditionPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
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NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
. G- 7 61
LOT BLOCK
OWNER.
3. k/1 i /%' ;'; J
4. ADDRESS
ADDRESS
27/ ( ?D if 2 ,v'
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
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CONTREIC,TQR
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
9.
❑ �rtW ❑ ALT.
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0 MECH.
❑ RPL.
❑ M.H.
DESCRIBE WORK
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V LU T k N SOURCEGAS ELECTRIC
OF
UTILITIES
PHONE
ZIP
PHONE
❑ MVE.
❑ POOL
WATER
0 OTHER
5
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S 24,
Actual Set Backs in Feet
North ISouth
Size of Parcel
Area of Decks
No. Baths
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Finished Basement Unfin. Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership
Public ❑ Private
Location (Area)
USE CODE
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
SPECIAL APPROVALS
NAME DATE
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Pianning
4-
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1-e) y v SIGNATURE OF APPLICA
Fire Marshall
Co. Engineer
Utilities
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Plans Examine!
SEPA Checklist
SPE IAL CONDITIONS:
No. Rooms
No. of Dwellings
Req'd. Rec'd.
FEES COLLECTED
Single $
Building " 5
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $�_
U2 *7500
*7500
*75.006
A '*0.00 8
395.6z
05--19-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
DATE ISSUED
4' 1'7. 9 Z
PERMIT NO.
* 7 5,00 a
TOTAL
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W . 25 or- 5
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