1982, 04-14 Permit 82A-2794 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — LUILLD!NG CODES DEPARTMENT
PERMIT NUMBER
779—
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
I -72O 6 c
LOT BLOCK SUBDIVTSION
IJ� r
3. � W��0� cdURcF1-AI fit, PHOI+L
ADD ESS
CONT ACT
4. ADDRESS
E
9
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
G
NEW
EB L D.
DESCRIBE WOR
8. V i V
VALUATION
9.
❑ ALT.
❑ PLMB.
SOURCE
OF
UTILITIES
PHONE
ZIP
PHONE
ZIP
TO
O AD N.
O MECH.
vlirJe
GAS
❑ RPL.
O M.H.
ELECTRIC
❑ MVE.
O POOL
WATER
0 OTHER
SEWER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
10 2
W i! or(,,114,..so c p,R), I5t,,
Actual Set Backs in Feet North (South East I0 (West I°
Siz of Parcel Zo - Classification
Tyke onst. Occupancy Sprinklered
Des ❑No ❑ Req'd.
Valuation/4 let)L Building Area in Sq. Ft.
Main Floor ( Upper Floors ( Garage Area I Storage
Area of Decks Finished Basement Unfin. Basement
No. Baths
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private
USE CODE
Req'd. Rec'd. Not 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 INSPECTION
DATE OF AFr' (CATION
!3
SIGNATURE OF APPLICANT
PECIAL APPROVALS
NAME DATE
Ping
ire arshall
Co. Erigine,er
Utilities
Plans Examiner
SEPA Checklist
Buildin Techni an
SPECIAL CONDITIONS:
7
RA4,141c1 Ptru. getPa (1.401511, e)
rf 0- rtic1.4' 44es5% O.) -
‘7tec,a4-16-Aje
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home 50
Other (Specify)
TOTAL $ ro
07* *5C00
* 5C00 17)
* 5C006
A *C00
234,32
0'3-31 a82
$ 6.479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'4 4i-82 279.4.z *5O.0Oa� -
a
U
LLJ
u-
DATE ISSUED
PERMIT NO. TOTAL