1981, 06-19 Permit 81A-4315 MHPLAN NUMBER'
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
1
4. ADDRESS
CON;RIC,R
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1.lJ• I��v
LOT BLOCK
110
•
SU DI ISION
OWNER
3. 12 'ICam) 1 IC*/ 17
ADi DRE S
z 6
P ON
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
aaa17
100!
LLr5 A-1.-5v 64544-04.2.1
Actual Set Backs in Feet
North'1i 'South ii 1East !West
PHONE
Size of Par el
471.) x
Zone Classification
ML&1t
ZIP
Typp IConst.
k
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
aluation
(COO
Building Are in Sq. Ft.
ADDRESS
ZIP
IM'a�iin`` Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
NEW ❑ ALT. ❑ AD'N. ❑ RP . ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. M.H. ❑ POOL
8. DES
CRIUt Wi L(' F- '.i�i (14 X —7o
VALUATION SOURCE GAS ELECTRIC WATER
OF
9�;�U OF
❑ OTHER
SEWER
No. Baths
No. iStories
No. Rooms
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 regulatin . trhJCtyn or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS n
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
6/5/23/
Fire Marshall
Co. Engineer
l�lar 12Ed0.
Utilities
Plans Examiner
SE PA Checklist
SIGNATURE OF APPLICANT/
SPECIAL CONDITIONS:
Req'd.
Not 6teq'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home ✓O
Other (Specify)
�' GO
TOTAL $
07* *5000
*5000
*5000U
A *0.00 8
431.49
05-05-81
. 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Bu g Te
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
05;-45-81 4315z *50.00°F-
DATE ISSUED PERMIT NO. TOTAL