1981, 07-06 Permit 81A-6674 MHPLAN NUMBER
APPLIGATIVni P'tulMI I
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
LEGAL DESCRIPTION — SEE ATTACHED
3.
4.
LOT
OWNER
BLOCK
ADDESS
CONTR,AC QR
ADDRESS `i�+%
SUBDI ISION
pi �rx N1� ✓ Pt
PHONE
PARCEL NUMBER/S 076'44 C+
Actual Set Backs in Feet
North 'South 'East 'West
Size of Parcel Zone Classification
ZIP
DESIGNER
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
8.
9.
11/EW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. M.H. ❑ POOL
IBE
V A Lt tot RK
VA - & 1 (1 4> c7 O
LUATION SOURCE GAS ELECTRIC
OF
UTILITIES
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum, Dist. I Location (Area)
Ownership ,�,/
Public ❑ Private I4
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 / hg I8I SIGNATURE OF APPLICANT
Rec'd.
Not Read.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
SPECIAL APPROVALS
NAME DATE
Env. Ideal
126610
Planning
Fire Marshall
Co. Erigineer
of o -
Utilities
Plans Examiner
SEPA Checklist
Build cian
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
Plan Check
SEPA
Mobile Home %U
Other (Specify)
TOTAL
I 74--
u7* *50.00
*5000
*50.006
A *000
667.3R
of-06-81
L? 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
:0$-4)$-81
667.45 :*50,00°1-1
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT NO. TOTAL