1981, 02-05 Permit 81A-1186 AdditionPLAN NUMBER ,.
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(PERMIT 4",MBER.
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APPLICATION/PERMIT
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
5.• 3 79-1 RnA121,d
LOT BL CK SUBDIVISION
OWNED
3. /I�
Fl
ADDR SS
. l.77 -.1 I QA 2V\A 1'
HONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S y I
0 • €,a' , ,7--e '`1 or- V\1 1/2_ •ncc.
ZIP
g:-Ic.p
CONTRACTOR PHONE
4- ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
PHONE
ZIP
TO
❑I NEW ❑ ALT. LJ AD'N. ❑ RPL. ❑ MVE.
IYJ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. 0 POOL
❑ OTHER
Actual Set Backs in Feet
North (South C' 'East fc-" In jWest C�
Size of Parcel Zon- Classification
6 tip.
Tyg`on
A Const.
Valuaati
Manio' 97
or
Area of Decks
Occupancy
Upper
Sprinklered
Elves ❑No ❑ Req'd.
Building Area in Sq. Ft.
,39
Floors Garage Area I Storage
Finished Basement Unfin. Basement
No- Baths
No. Stories
No. Rooms
No. of
Dwellings
DESCRIBE WORK
8.
VALUATION SOURCE GAS ELECTRIC
OF
9. UTILITIES
WATER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
SEWER
I L'
Ownership
Public ❑ Private
USE CODE
I hereby certify that 1 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
-3 -�
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Planning
Fire Marshall
Co. weer
►�oT I?r4'd
Utilities
Plans Examiner +Z,
TaM 1�os11 W?.f7 I5/11!
SEPA Checklist
uildin hnician
SPECIAL CONDITIONS
a
G
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not RegId.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
-
TOTAL $ 61(3
02* *80.00
*80.00
*80,006
A *0.00
111.32
02-03-8.1
2 6479.
•
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.18.'6g *8O.00-
DATE ISSUED PERMIT NO. TOTAL