1980, 12-29 Permit: 80B-5228 Inspectear:` VAV' sue;
APPLIA
is /a517b p spoKMI,oGQ TY C .K
NORTH 811 JEFFERSON SPOKANE, WASHINGTON 90280 / 16011.63675
PERMIT NUMBER
L3 -62.2
VENT
APPLICANT: COMPLETE NUMBERED SPACES
JO AD[� DRESS
z 48 I iI 1482,04-0..8481,84.8Q4 (-Ana
a ��J
F /De /7
COT ACTOR
s> ,o .041 L
DESIGNER
6.
- PRESS HARD TO MAKE 3 COPIES
PosoNE
9:J1-4797
L -4797
ZIP
qy
P„ozeb
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL D mBER/S /8,53/ - 4216
,Ler 4, 134.k- .9
QPPEK COLD MR /A ADP
IP
PHoNE
ADDRESS
a
CHANGE OF USE FROM ITO
TYPE $7 NEw 0 ALT. 0 *D•N. 0 RPL. 0 NYE.
T, OP SL 0 OTHER
WORK O. +� PLMS. 0 NISCH. 0 m.H. 0 POOL
Actual Set Backs In Feet ,
North pF7 ISoutn2J ow / 57 Iwe.40
gsnnutlon
asx2t -tiJ 0,14.1,,,PL
N. . 1 occupancy
R-3 0ym Ono 0 Roe,
r olna Am In Se- b NN A ul go
8 o o. I U.N. P I- FFmm.a B...m.m I•• nG B .nt
Arm of Dwhs 8/ oteCavOREF
No. Baths I Ne S I Rooms No. of Dwellings
./ tw Re et Ree'o.
CERTIFICATE • .c 4. IFv
of EXEMPTION 1 R 1 X
a
ESGRIB WORK
A UAT ON SpURCE
g,. 9 7•TILAIE
61111T. MM. I LOUtbn (MOO
ATEa y I Use coos
Public 0 Private
SEWER
I hereby certify ;Rat I have read and examined this application and have read the "1,10110E:" provisions included
.verse on side, and know the same to be true and correct. All provisions of laws and ndinances 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 /[`,
SIGNATURE OF APPLICAN`
DATE OF APPLICATION ,t2'2 2 -26
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
(4-1
a('/,u yw.f. oK
-e
FEES COLLECTED
Sinyle $
7# e0
Building /93•
Plumbing
Mach.
Plan Check
SEPA
Mobil. Hone
Other lSpecifyl
TOTAL s /931-12
02. *19300
*19300 B
•193008
1/
•000 8
52273
12 -24 -80
3 6479.
ADDiESS
DATE REMARKS /
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