1981, 06-30 Permit 81A-6488 AdditionPLAN NUMBER
/ &iA 3,97
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JO ADD
RESS
t11a? 5eoRDVJ/1-
LOT BLOCK SUBDIVISION
3.
4.
OWNER
V A. A \z-IN5
ADDRESS I }p� J s,
(..: � 1 Z� �3 1` 6 f�r. �-1 � r'
CONTRACTOR
�J� E
ADDRESS
DESIGNER
6.
ADDRESS
CHANGE OF USE FROM
TYPE
7, OF
WORK
,NJ,/NEW
BLD.
❑ ALT.
❑ PLMB.
PHONE
ZZ-0-a`a3
ZIP }}
PHONE
ZIP
PHONE
ZIP
TO
2r/AD N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S i�1 Ty Ni fQCp'
CIF W `/ CDFT1-4.o FtrC: �➢,;;'
1C0s43-oPo
Actual Set Backs in Feet
North 4) 'South
Size of Parcel
o �
East West ZQ�
Zone Classification
AeJ
Type Const.
Occupancy
Val ion
4. 37c2
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
•so
Main Floor Upper Floors Garage Area
1So
Area of Decks Finished Basement
Storage
Unfin. Basement
No. Baths
No. Stories
1.
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
DESCRIBE WORK Enum. Dist.
8. ADD IT 3 oN Yo MCC"
VALUATION SOURCE GAS ELECTRIC
OF
9. UTILITIES
WATER
SEWER
SCPTKI
Ownership
Public ❑ Private ❑
Location (Area)
USE CODE
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 UK) E SIGNATURE OF APPLICANT 1/�( Q�
SPECIAL APPROVALS
NAME DATE
Env. HI
Planning
Fire Marshall
Co. Engineer
Utilities
Cpllans Examin
SEPA Checklist
BuiJ�#+p
t(/j/�
hnician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 5C) .c
02* *50.00
*50.00 175
639.4�
0.6-26-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
181' 648.8z *503'0a1-2 -
DATE ISSUED PERMIT NO. TOTAL
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