1980, 10-27 Permit: 80B-2684 Residence�PLAN NUMBER
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Basic Plan
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
1.
2.
3
4
JOB ADDRESS
dig
LOT BLbCK
7 I /
OWNER
SUBDI 1 ION
LEGAL DESCRIPTION — SEE ATTACHED
ADDRESS
%-C 72,/ (tG
COJVTRACTOR
• TRESS
LIC�vLL
DESIGNER
5. ADDRESS
PHONE
ZIP
PHONE
PARCEL NUMBER /S
A.07 7 434-K /
FORA DD17-1N
Actual Set Backs in Feet
North 77 ' lSouthrt.D
ZIP
Size of Parcel
ir-5-
Type Const. Occupancy
East WestL�
Zone Classification
prinklered
❑Yes ❑No ❑ Req'd.
PHONE
ZIP
pluation
Main Floor
Building Area in Sq3 Ft.
QGG
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
k NEW
BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
5PL/
CERTIFICATE
of EXEMPTION
No. Rooms No. of Dwellings
Req'd.
Rec'd.
D,SCRIBE yIORK
8. VALUAT
-154'
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
SOURCE
OF
UTILITIES
AS
ELECTRIC
Enum. Dist.
ILocation (Area)
WATER
SEWER
Ownership
Public ❑ Private IQ
USE CODE
DATE OF APPLICATIONee � —�� SIGNATURE OF APPLI NT
SPECIAL APPROVALS
''NAME DATE
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
/Es 'Iding Te hnier)
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
zij ov
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
*211.00
*211.00 N
*211.006
A *000
20012
10 -15 -80
6479,
a
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'0 2"7 &0` 268.45 *211. 011a�
DATE ISSUED
PERMIT NO. TOTAL
A
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ISCY
414-14.
9CD
4401
(441,44.0
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