1980, 09-04 Permit: 80-9637 Remodel Bed, Bath, Family RmPLAN NUMBER ..
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. /' f 9 A i K FA K p,R J VE..
LOT BLOCK SUBDIVISION LE NA 5.1.4 Ai 'Agf( a.XGEPi
2. 2 3 S G, io'AKIO SW .Z5-1
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3 JIM UPCH iAR -= =N
ADDRESS
PHONE
PARCEL NUMBER /S 2654?. - J9 041.,
s J .F19 AIg.PAKK P121VE Vi1
CONTRACTOR
'• SAME.
ADDRESS
ZIP
PHONE
Actual Set Backs in Feet
North L' V' ISouth j East 26_ (West 3
Size of Parcel Zone Classification
,2.G'X 13 -'
ZIP
Type Const.
A
N - /vl A
Occupancy
R-3
,,;//\16:1LE FAmiLy EEs
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
ADDRESS
ZIP
Valu tion
Main Floor Upper Floors
7+-:
Building Area in Sq. Ft.
71'
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basemen
Unfin. Basemen
TYPE
7. OF
WORK
❑ NEW L7 ALT. Et AD'N. ❑ RPL. ❑ MVE.
013LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK MI 1-1, i agoRzom
810 6L— I X )s—nNC7 6-,ARtk E, a e zEwhy -r PAM IL�/,2,0 6k,
VALUATION SOURCE GAS ELECTRIC WATER I USE CODE
DU OF Ownership 'r`s''✓'t
9. b)`jQZ/ UTILITIES &X Public I=1 Private
1 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
No. Baths No. Stories
r
CERTIFICATE
of EXEMPTION
Enum. Dist. 'Location (Area)
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env alth
PI nning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
1:b/H p T LE1.0 t /54i
SEPA Checklist
SPECIAL CONDITIONS:
H l < )KID
ter.. ?-4e-lead
PERMIT IS NONTRANSFERABLE
No. Rooms
2
No. of Dwellings
Req'd.
Rec'd.
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
�62 *74,00
*74.00 In
*74.006
E *0,00
927,52
08 -28 -80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'09:! -0 4' -8 0' 9'6 3,7' * 4, 0
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
J
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