1980, 07-23 Permit: 80-7551 ResidenceAPPLICATION /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
1. /1 /zoS'
SUBDIVISION
LO T
2. 8
'* T /ES
LEGAL DESCRIPTION — SEE ATTACHED
BLOCK
y
ppE2 GoCc, ,c3/4 /9}0.D.
3.
OWNER
ADDRESS
C5r,/5 ieGtci7 0d+/
6--. /?? ?z Soacercie,ie
CONTRACTOR
4' ADDRESS
DESIGNER
J. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
tr/BLD.
E W
EI /BLD.
❑ ALT.
❑ PLMB.
PHONE
9ZZ— 1t87
ZIP
PHONE
PARCEL NUMBER /S /8537 .off
Actual Set Backs in Feet
North Z6 'South SS I East /O
IWest
ZIP
PHONE
ZIP
TO
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
Size of Parcel
Vz i4e
Zone Classification
/AA. • :".1-18
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valu tion
35 56 8
MaaiinFloor
/ 3W
Building Area in Sq. Ft.
Upper Floors Garage Area
Storage
Area of Decks
80'
No. Baths
Finished Basement
No. Stories
Unfin. Basement
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. %.5'dA, Cf- thi41/4 Y /?EC
VALUATION SOURCE GAS
OF
9. UTILITIES
Enum. Dist.
4gziar
ILocation (Area)
ELECTRIC
WATE R
SEWER
USE CODE
Public El Private 11 1
I 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 pe t does no
to give authority to violate or cancel the provisions of any other state or local law regula Ing , onstru
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health .
E7/k
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner •-7
SEPA Checklist
Build in Technician
s9- -7%
SPECIAL CONDITIONS:
Ownership
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building AO/ 1: m�
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ Zlq. 0C►
PERMIT NUk.IBER
-75s, 7
02* *21900
*21900
*219.006
E
*C00
742.58
07- 21--80
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
-
7 55.15 X219.0;0 ° r-
PERMIT NO. TOTAL
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