1981, 12-22 Permit 81B-2924 MHPLAN NUMBER
APPLIL R I IVII/ rcrsm' u
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
EAST 11920 MANSFIELD
LOT
2.68
OWNER
ADDRESS
/1✓, / 2 907,2 //%'/ / g,24 /la to a/a
BLOCK
CONTRACTOR
SUBDIVISION
PINE CROFT MOBILE HOME PARK
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PINECROFT ADDITION
09544-0421
ZIP
PHONE
Actual Set Backs in Feet
North (South
Size of Parcel
East !West
Zone Classification
4' ADDRESS
ZIP
Type Const.
Occupancy
DESIGNER
PHONE
Valuation
Sprinklered
Eyes ❑No 0 Rec'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE 0
6.
TYPE
7. OF
WORK
F USE %RC,
❑ NEW
❑ BLD.
TO
/V/%,
Area of Decks
❑ ALT.
❑ PLMB.
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
O MVE.
O POOL
0 OTHER
No. Baths
Finished Basement
No. Stories No. Rooms
Unfin. Basemen
No. of Dwellings
DESCRIBE WORK
8.
9 0Si-i7/ a.fiO4
VALUATION SOURCE
�/'��d O F
7 UTILITIES
i7 n1cb/4/e 4osrle.
GAS ELECTRIC WATER SEWER
IP P u'uu,"P
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 7Z/ /4�� SIGNATURE OF APPLICANT
CERTIFICATE
of EXEMPTION
Enum. Dist. Location (Area)
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Efngineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
Ownership USE CODE
Public ❑ Private Q
Req'd.
Rec'd.
Not Rei11d.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
I N, - 2-9;24-
07* *50,00
*50.00 17)
*50,006
A *0.00
29232
12-22-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
rn r onDv
u, T hn ian
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
1.262
DATE ISSUED
PERMIT NO.
292,4z *50.00a,
TOTAL