1981, 09-03 Permit M81A-3967 InspectBER
APPLICATION/PE
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 002e0 / 16091 4603816
2.
3
4.
APPLICANT: COMPLETENUMBERED SPACES — PR : 1IA110 TO MAl r- ',COPIES
JOB LOTADDRESS
I BLOOM SDL,iVitV 1°14
°341,) I•A II,i,{'I*Jo6
oN.e.�• r�ss�oJ
ADDRESS
777`A�
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
A We Set Becks In Fe.
[South tEels Lest
HONE FU oI Parcel •e
ZIP
Type Cons.
Occupancy
Zen. CHulllutlon
Sininknr.d
OVes ONe 0 Reg,
DESIGNER
6' ADDRESS
PHONE
Vsluatien
Building Area In SE FL
21P
Mein floor
UPPer Floors
rrag. qna
CHANGE OF USE FROM
e.
TO
TVPE NEW 0 ALT. ❑1fD'N. 0 RPL 0 RIVE.
7, OF
WORN ❑ BLO. ❑ PPM,('J MECH. ❑ M.H. 0 POOL ❑OTHER
VALUATION
9.
SOURCE OAS
UTILITIES
ELECTRIC
AT
SEWER
Area Of Decks
Finished Basement
No. Bath 1 No. Stories
No. Rooms
Unlin. Segment
No. of °welling
CERTIFICATE
of EXEMPTION
Enum. Olst. I Leutin. (Area)
1.00 Thrusts
hNele ❑
USE CODE
Re0'E.
1 hereby certify that I hese reed and examined this application end have read the 1110141.Ni
side, end know the same to be tme end correct All provisions of laws an.: osi 0Ovetllele IIA9
mr reverse 11" type Of work will be compiled with whether specified herein or not. The grantilig.,l . ',..i•t• .Ines not Iiintimi•
to give authority to violate or cancel the provision, of any other Slate or local law Ii n1 .1 , I e1511os.I.In1 111 I,
•
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIIOONNS�r&RI SIGNATURE OFAPPLICANT(/LrD�XLEI//%1LI, E'
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env, lieellli
Es& ee
SPECIAL CONDITIONS:
Res•d. rI Rood.
FEES COLLECTED
SINE S
Budding
Plumbing
Mesh.
Pl.n Chests
BEPA
Mobil. Home
Other ISpecilyl
M
UM ER
81A — .J3(
i.pr a
(14-27-8.1
clQ
• 1 7 0
1700/
f'
It
TOTAL S 11 •
WHEN MACHINE VALIDATED
N II N. 51'AC
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR " TYPE OF WORK
FINAL INSPECTION: /c2 —8(
NSE W
SET BACKS
DATE REMARKS: /� / y/
/— 7- / uG�� ill�r1,(9 c�l42 %eff� Arf krt7 /`h�/� 5/
aid 6 7) fai„fit 112e,7:/ 1�:�T, ar7-S �st Xr)
b m � ��t s47w Rdj
/2-3-61 C:c ;n4tea 01 47*)