1988, 04-27 Permit App 88000979 MHM1
SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
• NORTH 811 JEFFERSON
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct. In
addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. I understand that the issuance of this permit and any subsequent inspection
approvals or Certificates of Occupancy shall not be construed to give authority to '.late or cancel the provisions of any state or local law r gulating construction, or as a
warranty of conformance wit provisions of any stater local laws kgulating / struction.
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
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INFORMATION WORKSHEET
PARCEL NUMBER : 1 3 0) ()
STREET ADDRESS: Jy . (p 03 1
CITY/STATE/ZIP: \JC- Y'CL- A- \ P aJ 9 l 0 a
SUBDIVISION: — Si - 52.5
BLOCK: LOT: ZONE: A6W. DISTRICT:
LOT AREA: F/A: WIDTH: /(pi DEPTH: R/W: kin
# OF BUILDINGS:
# OF DWELLINGS: f WATER DISTRICT: 'kf�E A
OWNER: i�sl\e��/��c) e_A 1-
MAILING ADDRESS: (0 Q \ \ n rcx.,_
CITY/STATE/ZIP:
PHONE : 50
42,
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CONTACT : pL .R Q %e-\ (LS)PHONE:
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE: ne)C48LC-_ CJ)iD 2$ X 2
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CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
BUILDING INFORMATION
PHONE:
•
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS:
REQUIRED PARKING:
X (WIDTH X DEPTH) SQ. FT.:
# HANDICAP: SEWER (Y/N): HYDRANT:
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TEL NO:509-456-4716
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