1980, 01-24 Permit: 80-538 MHPLAN 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 4 COPIES
3.
4.
JOB ADDRESS
LOT BLOCK SUBDI ✓ISION
PH — , "71
OWNER
1 --f i71 L(L��I
ADDRESS 6[ V J � 1 [O 1
//CTQF2_ Nil
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S 17177 1
ZIP
Required Set Backs in Feet
North 40 'South Y'
(East C 0 'West
PHONE
Size of Parcel
e' x �h
Type Const. I
ZIP
Zone Classification
/ 9T7• Howlr
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
pyvL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Ranche
TYPE
7. OF
WORK
LJ NEW ❑ ALT.
❑ PLMB.
❑ BLD.
❑ AD'N.
El MECH:
,. ❑R P L.
—,I
A!J M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
H
V H °ATiI O
9. 2 5 COO
Cuurce
of
Utilities
GAS
ELECTRIC
T
SEWER
I hereby ceFtify 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 permi not presume
to give authority to violate or cancel the provisions of any other state or local law regul : i ng instruction or the
performance of construction.
rJ g..' � / /
7
DATE �� SIGNAT .a4 I /1/ !4
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPEC! CONDITIO' ::
IL TO o tA/►�
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home 1 00
Other (Specify)
TOTAL
PERMIT NUMBER Q�
— 6 3
DATE
07* *10Q00
*100,00
*100.006
E *0, 00
44.72
01 -22 -80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISoBrO7E ApErIT.
5385 . *100.002111
T
RECORD OF INSPECTIONS
Final Inspection
REMARKS INSPECTED BY
\ 6
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