1981, 03-03 Permit 81A-1941 Inspect37s/ k/
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODESDEPARTTMENT
NORTH 811 APPEASE,. / SPOKANE, WASHING
APPLICANT: COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 3 COPIES
V 4�(0 151ory
I f/ r414 '& af QO I1-
OWNER 6 . I r s1!)1�
a ttdn�K_�
ADOPF�S, 371� 5'ft
ZIP
NE
-77 •7
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER 2.3.10.4.S 2_ — a
do. 13 L "( I0
PM
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TtP.ICnnn, ° �i
°ESIONEN
Q ADDRESS
CHANGE OPUS[ PROM
TO
PHONE
IP
TOPS IRNEEW 0 ALT. 0 AWN. 0 RPL. ❑ PAVE.O OTN[R
%, OP RN '6W 0 PLMS. 0 MECH. 0 M.H. 0 POOL
WO
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yV UATI� SOVAC[ OAS ELECTRIC I'_.ATgR !EWER' Pblic0 USE CODE
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I hereby certif/ that I have reed and examined this application end have read the "NOTICE" provisions included
on re side, and know the some to be true and correct All provisions of laws and ordinances governing this
type ofwork Nill be complied with whether specified herein or not. The granting of a permit does not presume
to give autl,Dlity'td v)Glale or Mod the provisions of any other slate or local law regulating construction or the
t - nco .Lronstomil0R. BEE REVERSE SIDE FOR REQUIRED INSPECTIONS -yam. }� 1j,1��
TE OP APPLICATION i) !
_i"A/ SIGNATURE OF APPLICANT )f k ` "tea " " "
o. B.lfl I No. etarlm
N
CERTIFICATE
of EXEMPTION
nu . Dbl. tlon (Area)
SPECIAL APPROVALS SPECIALCIjCONDITIONS: A. ✓,/l�q �y, �y 'I/ �y�I,(j
NAM[ DATE 1 n TV'V11V41 T\I r i T"rF�t/ '�I 1 1 , ^ iFcl✓
raA Jl� �1' I?• Alonlcotinferau1& ),or— 0 VaR41IC d
y, TMOWN Horne
nfln. Payment
7.3
Reom, No. of OWMI Ms
SOO d. nee d. ►IofKRp'!.
FEES COLLECTED
C2• •1060
•12600`
o 1 0 400 tl
I9& 1I ,.;fie,.
03`02 8:1f..-.
Or, FEES- Ina* es,90/ t.
J=_
—_. Ane.yadf
ii Iil,niktr K 4i041l6 1Jo-( I ' /%2�1/
SIIgM
EA Ming
Plumbing
Mph.
Nen Check
Other (Specify �r
TOTAL
WHEN MACHINE VALIDATED IN THIS SPACE,
ADDRESS
DATE
INSPECTION RECORD
REMARKS
:4111 —7
"7111 UP5«'`^• -E'P5Zay //i40 ClCdO4Q- ,et;)
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