1981, 12-07 Permit 81B-2519 MHPLAN NUMBER
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. G. J/Rzo MANSE)ELi7
SUBDIVISION
LOT
2. ! /
BLOCK
s PA-c 77
OWNER
3. a��.S AN S M'4rr-r
ADDRESS
N _ LH ; M` PuNIACP
CONTRACTOR
4' ADDRESS
DESIGNER
5' ADDRESS
6.
CHANGE OF USE FROM
TO
PHONE
`fZ.2—o377
ZIP
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S o 75 44- 011-21
Pi NJIE.c 1?-4 T /120731 LE- NoM r/1R
LIST S 'f 3- so
Actual Set Backs in Feet
North 'South
Size of Parcel
51.0
pf5' x
Type Const.
Occupancy
rL- 3
Valuation
$ /60ooQom.
Main Floor I Upper Floors
Area of Decks
East 'West
Zone Classification
N1 1-- -1 •FAIN 11,..y
Sprinklered
Oyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
`780
Garage Area
Finished Basement
Storage
Unfin. Basement
TYPE
7. OF
WORK
D NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
z
No. Stories
CERTIFICATE
of EXEMPTION
No. Rqoms
Req'd.
No. of Dwellings
J
Rec'd.
Not Req'd.
DESCRIBE WORK
s. jl�to iL }OME-
GAS
9.
VALUATION
SOURCE
OF
UTILITIES
ELECTRIC
Cl`f' X "7o
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 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
No-1-
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
00
0
Oc;
$ 5O " vc
yI , -zsiq
0,7 *
*5000
*5000 ri
251.8z
12-07-81
o. 6,479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
C
c
L
L
Building Technician
PERMIT IS NONTRANSFERABLE
12-'07- 81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
25L:9g *50.002�
PERMIT NO. TOTAL
Mo -i . n bYNE
1'eYZG!