1981, 05-11 Permit P81A-4543 SprinklerPLAN NUMBER
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
E. \u5i rGYzQ �i �wir
LOT
BLOCK SUBDIVISION
OWNER
3.
ADDRESS
CONTRACTOR
4.
ADDRESS
SAM
DESIGNER
5' ADDRESS
IACL oAki.0
PHONE
CA2.6.0 _IZO.7
ZIP
�1K12L,C
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North [South [East (West
Size of Parcel
Zone Classification
ZIP
PHONE
Type Const.
Valuation
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors • Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
LeJ NEW
❑ BLD.
DESCRIBE WORK
❑,,/ALT. El AD'N.
MJ PLMB. El MECH.
8. I.-04 ,, w; S?2 %N
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
❑ RPL.
❑ M.H.
ELECTRIC
❑ MVE.
❑ POOL
WATER
El OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. 1 Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
Req'd.
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 INSPECTIO
DATE OF APPLICATION
SIGNATURE OF APPLICANT
}cwv�.l�P
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Rec'd. Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
eo
TOTAL $ __` . CC
PERMIT NUMBER
03* *9.00
*9.00 tn-
*9.006
A *0.00
45&2
05-\f1 -81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
L
Builnchnician
99
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0'51-11=81
DATE ISSUED
45435
*7.00Jo
PERMIT NO. TCTA.L
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