1981, 12-22 Permit 81B-2926 MHPLAN NUMBER
PERMIT NUMBER
6115 -- 2,724,
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. f- . ((C C, MA1v5FiE�o
LOT BLOCK SUBDIVISION 1
NJ E C� -C \043 t L `A0t'IAE.
2. 5�
OWNER
PHONE
S71
LEGAL DESCRIPTION — SEE ATTACHED
PA 2CEL NUMBER/S
Oct `544 - Cj4-a._ ‘
ADDRESS
7Gic - -a
CONTRACTORCONTRACTOR
4.
5.
ZIP
CA CA
PHONE
Actual Set Backs in Feet 4'X, Ttn)(
North !South East (West
Size of Parcel 1 Zone Classification
iZirvk i-t
ADDRESS
DESIGNER
ZIP
PHONE
Type Const.
-' v
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
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
L10 NEW ❑ ALT.
❑ BLD. ❑ PLMB_
❑ AD'N_
❑ MECH.
❑ RPL.
VM.H.
❑ MVE_
❑ POOL
❑ OTHER
No. Baths
No.
Stories
No. Rooms
6
No. of Dwellings
Not Redd.
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
DESCRIBE WORK
8.
VALUATION
SOURCE
OF
UTILITIES
s!VLG t3 c c .. k o rr (144-K 7C-)
GAS ELECTRIC WATER SEWER
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private
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
S GNATURE OF APPLICANT ' S"
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 $ 50. on
07* *5000
* 50.00
* 50.006'
A *0.00 E
292.5
12-22-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
nig Technician
PERMIT IS NONTRANSFERABLE
12-22 81
292.6z *50,OOaf