1981, 11-09 Permit M81B-1641 Wood InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456.3675
JOB ADDRESS
�- , 1 � 56*I 55
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
BLOCK
SUBDIVISION
OWNER
3. 6L,erViV (1cDtz-tIVs
ADDRESS
E • f503 (IA ISS tovi
CONTRACTOR
4. S f-Mj
5' ADDRESS
ADDRESS
DESIGNER
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
Q etO
PHONE
ZIP
PHONE
ZIP
TO
VI NEW 0 ALT. 0 AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. 11/MECH. 0 M.H. 0 POOL
DESCRIELE WORK
8. iAJCXjD3(...tRAN fk) Ct
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
0 OTHER
SEWER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North
Size of Parcel
Type Const.
Valuation
Main Floor
South East
Occupancy
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area In Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
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 ( (. SIGNATURE OF APPLICAN
No. Rooms
Storage
Unfin. Basement
No. of Dwellings
Req'd. Rec'd.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. 4'11 : °C
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 17, E'C'
lI
PERMIT NUMBER
04* * 1 7,00
*17.00 1-6
164.02
1:1 ,-09-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
B Iding Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
DATE ISSUED
164,1Z *17,00 -
PERMIT NO. TOTAL