1981, 07-14 Permit App 81A-6961PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT BLOCK
SUtiUI VISION
3 OWNER)4I J - O 1�-FL
4.
6.
ADDRE
. to I1IC�
CONTRACTAR
ADDRESSc? u Gf
DESIGNER
ADDRESS
CHANGE OF USE FROM
TYPE
7. OF
WORK
43\1'
ZIP
2-10
PHONE
ZIP
TO
NEW ❑ ALT. 0 A N. ❑ RPL. 0 MVE.
❑ BLD. ❑ PLMB. MECH. 0 M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North ISouth East (West
Size of Parcel
Type Const.
Valuation
Zone Classification
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
Building Area In Sq. Ft.
Main Floor Upper Floors Garage Area Storage
Area of Decks
No. Baths
Finished Basement
Unfln. Basement
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec d.
DES,CIjU�IBE WORK
8. CC,k2
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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
3 9\r-
DATE
OF APPLICATION
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. I 7-
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 17-
U�! . * 1 7.00
* 1 7.0.0 t
*17.006
A *0.00
696'0.
07— 1 4-8-1
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
69F6,1Z *170,0 11):171-
PERMIT NO. TOTAL