1982, 07-21 Permit 82A-6265 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTS - BUILDING CODES DEPARTMENT
IPLKIVII 1 INUIVIDcrt ��I
.A—Ce' Ce
NORTH 811 JEFFERSON i SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
JOB ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
LEGAL QESCRIPTION — SEE ATTACHED
LOT
2. SJ
OWNER
BLOCK SUBDIVISION
0, 4-4 -r
1 (10 i 1.-€
3TEil� %�\�•->'c.+4�t�
ADDRESS
l+GZc> '1"'1A. SC(E.`p -s*-='-`-'3
4.
CONTRACTOR
ai�ly'v
ADDRESS
PHONE
ZIP
'2c:)
PHONE
ZIP
PARCEL NUMBER/S
CO61544" • 04=11
Actual Set Backs in Feet 0.4G
North (South East
Size of Parcel
Type Const.
Occupancy
`2%3
(West
Zone Classification
Sprinklered
Eves ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
ZI P
Val ation
2,
Main
Floor
Upper Floors
a-4
Building Area in Sq. Ft.
Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks
1•
Finished Basement
Unfin_ Basement
TYPE
7. OF
WORK
KNEW ALT.
❑ PLMB.
❑ BLD.
❑ AD'N.
❑ MECH.
❑ RPL.
E M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No.ftooms
DESCRIBE WORK
8. WADE —
VALUATION
9t2
SOURCE
OF
UTILITIES
/106 L.� Ni Ct4 C
GAS 1 ELECTRIC
WATER
SEWER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private
USE CODE
Req'd.
No. of Dwellings
Rec'd.
(Not $eq'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 ating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATI
7-021-e2
SIGNATURE OF APPL)CA
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
$
Mobile Home
Other (Specify)
TOTAL $
07* *50.00
*50.008
A *0,00
626.4E
07-21-82
2 6.479.
c
c
L
L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
din echnis• M
�GrI CC— 41
C
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0...77 2,1- 8 2.
DATE ISSUED
626.55
*50.00°I-
PERMIT NO. TOTAL