1981, 05-14 Permit 81A-4730 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILINNc?F CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS /,
1. �. 11G(Zc7 m(vvi2PttL
LOT
2.1tea
OWNER
3. 3
ADDRESS
N . G4DZ5
CONTRACTOR
•C*Y11 E,
4. ADDRESS
DESIGNER
BLOCK
5' ADDRESS
6.
SUBDIVISION "1 "
i�\NrCC2ii:=L OV: LC
ti\ii•:Vt.c:2 -r1/4.) `t*"i
CHANGE OF USE FROM
TO
PHONE
42A- - 3i'tC) _
ZIP
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S �tf\:I�C'2C:ir'.{ ADy.), ifOftii
01544-0}?(
Actual Set Backs in Feet
North J 'South-\ East 2-c✓ West
Size of Parcel
4e5:
Type Const.
TyA
�v
Valuation
tCL000
Occupancy
Main Floor I Upper Floors
fO24
Area of Decks
Zone Classification
M1ACTI — PAAAtt-Y"
Sprinklered
Elves ONo 0 Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
TYPE
7, OF
WORK
NEW
0 BLD.
DESCRIBE WORK
8. SIPILicE, (+V,0c
�t VALUATION
sn IG;000
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
❑ ALT.
O PLMB.
❑ AD'N.
❑ MECH.
❑,( R P L-
1U M.H.
❑ MVE.
O POOL
mcYE (LE. Yr1.J>v E 1te1/244)(, )
0 OTHER
No. Baths
1
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
SOURCE
OF
UTILITIES
GAS
DATE OF APPLICATION 5I ititt
ELECTRIC
WATER
SEWER
Ownership ,,,(
Public CI Private NJ
USE CODE
SIGNATURE OF APPLICANT
Req'd.
SPECIAL APPROVALS
NAME DATE
Env. Health
giktl')Ct
Planning
Fire Marshall
Co. Engineer
Mar 'REQ`D.
Utilities
Plans Examiner
SEPA Checklist
9old Technician
SPECIAL CONDITIONS:
40$/.G A/d/Ne B6/.4.'7� dei ate✓ oOfrt Cc W ifr
SI B` eepmeeo4c9 iryt4,64 tex7,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
1/
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home'�U
Other (Specify)
TOTAL
$mac 1.
07* *50.00
* 50,00 to
* 50.006
A *0.00 S
453.6g
05-11-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
015'714-811. 473.05 *50,0'022F
DATE ISSUED PERMIT NO. TOTAL
(ho',.G. it/401\01d
i? V