1982, 01-27 Permit M82A-650 Addition to MHPlanning
PLAN Nluv1BER
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
JIVI ✓ 2 I' .z. c' A' A ' )�
LOT BLOCK SUBDIVISION
OWNER
PHONE
ADDRESS
ZIP
CONTRACTOR PHONE
4. ADDRESS
A
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S . /Elafk .�i2 `k, C.,7'OCE p,)_
Actual Set Backs in Feet
North ISouth'3%.' East'4`6' 'West
Size of Parcel
•'12_?'3�.
Ii; gonst.
O;ccc�cupancy
DESIGNER
PHONE
5' ADDRESS
6.
CHANGE OF USE FROM
TO
ZIP
V Iuatiofl
Main Floor
to Q
Zone Classification
Sprinklered
Dyes ❑No Cl Req'd.
Building Area in Sq. Ft.
Upper Floors
Area of Decks
Garage Area
Finished Basement
Storage
Unfin. Basement
TYPE
7, OF
WORK
CI NEW ❑ ALT.
IBLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8-ADP 1 T‘c, 'TO
VALUATION
ed0e2
SOURCE
OF
UTILITIES
GAS
3 crn.E (2
ELECTRIC
WATER SEWER
veer
Enum. Dist.
Ownership
Public ❑ Private
ILocation (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,— SIGNATURE OF APPLICAN
Req'd.
Rec'd.
Not Fq'd.
SPECIAL APPROVALS
NAME DATE
e3th A
72h
Fire Marshall
Co. Engineer
Nor Reao
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS: t-o
ON Mol3��� ir•1c�,xe
c: s1 �� �IvSFL�C,: J j ,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 454,6Z
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ .5400
0.2* *5400
*5400
*54.006
A *0.00 8
64.9g
01-27-82
z 64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
V
0' 1L —,2 7 - 8 2
65.0'2 *5400°-
B Ading echnician
4 CI,
DATE ISSUED
PERMIT NO. TOTAL
1 _
I
re•
UJ A.
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