1982, 08-23 Permit M82A-7333 Gas PipePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
$2A- '7333
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
g.,. 11103 BRoADW
LOT BLOCK
OWNER
JUtSUI V I�IUIN
3. RAY VuFFkiiN
4. ADDRESS
ADDRESS
E.- I Ilo 3 L3R4A D WAY
CONTRACTOR
AIM -
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
q2Z - 5/120
ZIP
/3 2.061
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South East (West
Size of Parcel
Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq_ Ft.
Main Floor Upper Floors
Garage Area
Area of Decks
Storage
Finished Basement Unfin. Basement
TYPE
7. OF
WORK
❑ NEW ❑ ALT. 0 AD N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. I 1 CH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Stories I No. Rooms INo. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
DESCRIBE WORK
8. C Rs PIPS 41 S—
VALUATION
9.
SOURCE
OF
UTILITIES
:ii •
GAS
ELECTRIC
WATER
SEWER
Enum. Dist. I Location (Area)
Ownership
Public 0 Private 0
USE CODE
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 (��dR — SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
3 rtTol
CNIF✓ ot,(T'cE-r tt2.0a
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
00
Other (Specify) % �(.r
TOTAL
04* * 1 2.00
*1200
*12006
A *0.00 8
733.22
'08-23-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0'8,3 82'
DATE ISSUED
i
733.3z *1200aI--.
—
PERMIT NO. TOTAL