1981, 01-06 Permit G81A-113 MH HookupLH IN IVVNICER
L✓
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
2.
JOB ADDRESS
BLOCK S)22 -
LOI LOCK BDIVISION
WNER
ESS
4--L`4
C
4. 'G`J c2cti -te
DOE�SSR-
c� _.2
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
APPLICANT: COMPLETE NUMBERED SPACES - PRES3 HAD) TO MAKE 3 COPIES
,1 c
7-1 le
PHONE
92 y- 03 /
ZI
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East 'West
PHONE Size of Parcel Zone Classification
PHONE
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
TO
Main Floor I Upper Floors I Garage Area
Area of Decks
Finished Basement
Storage
Unfin. Basement
TYPE
7. OF
WORK
8.
9.
❑ NEW
❑ BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
❑ PLMB.
SOURCE
OF
UTILITIES
El AD'N.
MECH.
❑ RPL.
❑ M.H.
ELECTRIC
O MVE.
O POOL
0 OTHER
-Lt.
WATER SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private 0
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 INSPECTION
///,
DATE OF APPLICATION I— 6
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICA
SPECIAL CONDITIONS:
"y-0---r-A,..4 /-e/ra;A,
Req'd.
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
04* *1000/
* 1000 to-
* 1 0.006
A *0,00
11,2g
01-06-81
g 6479,
04* *2.00
*200 ui
*2000
A *000
11,4g
01-06-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
a
L
u
u
BIy{Itlin Tec O
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE nF IccllnnurF
1 1-3 ,
,1 I f