1981, 05-14 Permit 81A-4733 MHPLAN NUMBER
,57/O/r/
APPLICATION/ f'tKMI 1
SPOKANE COUNTY -- BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / 1509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
4
J B ADDRESS
LOT
2, 1- Va
ICtZO PA -I 1= i E i✓T?
BLOCK SUBDIVISION
w
�Ir7�crw r11lca(cx YEdry : u k
OWNER
3 t--LC- $?. rk
ADDRESS
te CA2L
4.
CONTRACTOR
ADDRESS
4r.,r
DESIGNER
5- ADDRESS
CHANGE OF USE FROM
TO
PHONE
ZI P
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S TtN T!,� ; !`t �p(T(DN
43 --So
Actual Set Backs in Feet
North tb r (South
4- c C 4
East
(West
?U 3
Zone
Size of Parcel Classification
7G 1aC 14PA1-c-V AZT t ttm 1C.�
Type Co
nst.
Valu ion
2)Lc c
Main Floor
LLB
Occupancy
Upper Floors
Area of Decks
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq.
�Zoc
Garage Area
Finished Basement
Ft.
Storage
Unfin. Basement
TYPE
7 OF
WORK
YJ NEW ❑ ALT_ ❑ AD'N.
0 BLD. ❑ PLMB. ❑ MECH.
DESCRIBE WORK
8.
UTILITIES
❑/� PL. ❑ MVE.
YEllM_H. ❑ POOL
0 OTHER
No. Baths
.Z.
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
VALUATION SOURCE
OF GAS ELECTRIC WITER SEWER Ownership .// USE CODE
SCT'T t (-: Public ❑ Private
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
imisk
SPECIAL APPROVALS
NAME DATE
Env. Health
_ELCsYSe)G, S `� IC•
planning
Fire Marshall
Cp. Engineer
NaT 4 R1CD .
Ulil ities
tl'lcit:E i-}O
pp3ns Examiner
SEPA Checklist
guil ing chn�a�
SIGNATURE OF APPLICANT
No. Rooms
''
Req'd.
SPECIAL CONDITIONS:
Mil/ L.._ -ID 0 W 6Ir w }104 2 4\D\i
N1t %LL Auk ( % Iniii "Pupa_ _ it t n, 4�044t { Lek ig L Ji 4E 2
RQcc),r7us MI'r I i�rrrlF U -AS t_c•GATMD - SA.l:fn-
i � <�10.lVlfi
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
No. of Dwellings
Rec'd.
Not 6req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
ck r
Mobile Home
Other (Specify)
00
100Xx
TOTAL $
07*
* 10000
* 10000
* 10000�
A *000
451,IJ
05-08-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
015-44-781
DATE ISSUED
47335 *100.0.0a,--
PERMIT NO. TOTAL