1980, 05-05 Permit: 80-4281 Living & Dining AdditionPLAN NUMI/23 R
— 53)
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS }'� �j q/�
LOT H0 OL I-} /B i/ �(�����`� t oAlo
OWNER
3. f ITVIa 2AN4 O
ADS
CONTRACTOR
ADDRESS
4.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
PHONE
� - 1067-
41 4Z
ZIP /��1�
PHONE
Required Set Backs in Feet
North �• 'South Y
East
ZIP
Size of Parcel
Type Const.
LAN
Zone
O
(West
Classification
af�I L.
Occupancy
g -3
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
■:i.O 5•
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6. -•
TO
Split Entry
Split Level
Rancher
TYPE ❑ NEW
7. OF
WORK/ 1 BLD.
❑ ALT.
❑ PLMB.
UZI:L ' N .
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
WORK
9. 9. JKA/INYI OP M o N I o ui N1 GA S x I T N
Utilities oP ELE
WATER
60M ►Atinl
SEWER
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.
DATE
DEPT.
Env. Health
SIGNATUR
SPECIAL APPROVALS
REQ'D. REC'D.
&evt-,fte 3/q/
X Planning c/4/1
y. / Le /I�� /- _IA'/
Fire Marshall
�� r�Y"/
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
1%160 INON APN ri'2I=1-
bt lco• A40 bl ion 1 5 1IO
-r "rA�7 VA�IA 2Oi1■1=
�dirW 1f4O
PLANS RPPRoVEP /j'�
DATE 3 -5 -80 OFFICIAL Titey,.g.)/�< 1
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building 35.0"
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other pecify
TO AL
Pr ERMIT NUMBER
I ,Sf6-
DATE `2—FD
02* *38,00
*38,00 ti)
*38006
E *0.00 8
428.02
05 =05 -80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
TH1 r 4MY ;
ESAPf-RMIT.
428.1 5 *38,O'o°
M
11/
RECORD oF INSPECTIONS
DATE - REMARKS
Final Inspection
INSPECTED BY
4-4 66,47,1
i
-