1981, 10-16 Permit App 81B-758 RemodelPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
v1_.7651
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRE.SS
2.
3.
4.
LOT
BLOCK
SUB (VISION
MPS. ovc-
OWNER
e DE-itekcr 0 - 2
ADD'RESS
CONTRfl
qt)
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
�Y�YJ
PHONE
PHON
PARCEL NUMBER/S .:1 6_6 7j 3 0 3
Actual Set Backs in Feet
North 'South
Size of Parcel
lEas
West
Zone Classification
ZIP
TypeeCpnst.
DESIGNER
5. ADDRESS
PHONE
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
E/NEW ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
MJ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Rgq'd.
OR
K DESCRIBE
8. j 1L:* F o
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
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 1 C/ / & �S/
SIGNATURE OF APPLICANT Si!40
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Ktr4 le
Fire Marshall
Co_ ngineer
Utilities
Plans rExaminer
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
02* *140.0
* 1 4.00• 0)
* 1 4,006
A *0.00
757
10-16-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 16-8'1.
7 5, 82 *140:0,ap' -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL