1981, 12-07 Permit 81B-2517 MH• i f
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT!JUMBER
/r3-2'aI7
PLAN NU1MBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
. E. 92O MA/ 5Fi ftip
LOT
2, / o3
BLOCK SUBDIVISION
-5P4c , /03
OWNER
3. Bl-S S iE \tag SAN D7
ADDRESS
N- 1,14o S M c oc e1ALD R D * 14--
CONTRACTOR
ADDRESS
PHONE
ZIP
2,�,!!
O
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S rm. Li.TTi
04,z
PINt-C iZoFT" Mo81 i i ME. PR-gK
SD
Actual Actual Set Backs in Feet
North 'South 1East (West
Size of Parcel
X 'v
Type Const.
v-N
Occupancy
Zone Classification
/11/1,11.--rl — P4 ml
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
Val4tion
Oc`
Main Floor
550
Area of Decks
Upper Floors
Building Area in Sq. Ft.
SSO
Garage Area
Finished Basement
Storage
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
DESCRIBE WORK I
8. 010 M,O8) LE_ I }2M (1 c• X' 5 S.'
9.
VALUATION SOURCE GAS ELECTRIC
OF
UTILITIES
❑ MVE.
❑ POOL
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. RoDms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum, Dist, I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
Req'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 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
AL
Planning
#
Fire Marshall
Co. Engineer
utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Req'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
r'oG
Mobile Home •�
Other (Specify)
Oa✓
TOTAL $ 50 %4C
p7*
*5000
*5000
251.62
12-07-81
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
12,07-8f 251.75
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT IS NONTRANSFERABLE
*5a00a-
PERMIT NO. TOTAL
N�
IQY5 )
•
4