1980, 12-18 Permit: 80-8705 Special InspectionAPPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
JOB ADDRESS
APPLICANT: COMPLETE NUMBERED SPAC S - PRESS HARD TO MAKE 3 COPIES
�. _
LOT
OW
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
4.
5.
6.
C
Actual Set Backs in Feet
North South
Size of Parcel
R
ESS
Zone Classification
Type Const.
DESIGNER
ADDRESS
CHANGE OF USE FROM
Occupancy
PHONE
Valuation
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
TYPE
7, OF
WORK
9.
Unfin. Basement
4A BLD. .
DESCRIBE WORK
VALUATION
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL. C MVE.
❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd. Not Req'd.
ELECT' C
WATER
SEWER
Ownership USE CODE
Private Public ❑
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 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
DATE OF APPLICATION 4- ! d' V SIGNATURE OF APPLICANT
SPECIAL APPROVALS I SPECIAL CONDITIONS:
Env. Health
Planning
NAME DATE
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
3uildin
ician
`J�in2ol�i� -v �
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)_8...
/5 ty"7
TOTAL $r�
PERMIT NUMBER
g -� 07° 5
*8.00
*800
870:42
08 -18 -80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'2r *i8+ .
DATE ISSUED PERMIT NO.
506, "9g•
TOTAL
i