1980, 12-11 Permit: 80B-4368 InspectAPPLICATION /PERMIT
SPOKANE COUNTY— BUILDING CODES DEPARTMENT
NORTH Sit JEFFERSON / SPOKANE. WASNINOTON 05250 / (MOP1456.3.75
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
.10• ADDRESS
LOT
2
PHONE
ADDRESS
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBERS
CONTR
...I
DESIGNER
ijat�i ► (,C4 4 Z
ONCR
S' ADDRESS
0.
CHANGE OF USE PROM I
ON
PHONE
Actual Set Backs F001 In FaIsonm
tn
Stn of Omni tom CRes cation
TVIM Conn. °memo SPIV .
Ova Dos Row.
Ro
Valuation Building AVM r I s
In R. Ft.
O n Floor OPPer F °off OSG• we SOPA,.
Me*
D women UM!, Basemen
TVP[ ![c...... I"1 Af T. 0 AWN. ❑ RPL 0 PAVE.
DD"IIJ ❑ Ml N 0 OTN[R
7. OP
WORN 0 [mod. 0 . 0 M.H. 0 POOL
RISE WORK
& VALUATION SOUK
B. IVTILITIES�
O. Baths o. Stories No Roo No. of Dwellings
eElf/ fewgl,eatr /.
ELECTRIC ER SEWER
CERTIFICATE
of EXEMPTION
nom. Dist. I LofetIPn (Areal
OwnHMIP
0110 0Printa 0
USE CODE
o.
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 permit does not presume
to give authority to violate or cancel the provisions of any other state u. local law Iegulallng construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS / / /�J
DATE OF APPLICATION . Zf L ./F•C.) SIONAIUNE OF APPLICANT L /vaE• �J
bre
SPECIAL APPROVAL[ SPECIAL CONDITIONS:
NAM. DATE
Noah
na Examiner
4
/GO A
/ g2 s) 9
FEES COLLECTED
9'101
Building yg.pp''
Numbing JeabE Y
Mech.
Plan Check
•EPA
Mobile Noma
Other (Se.olfyl
TOTAL •
ex
P(PERMIT NUMBER
XD(3 '1L
3• .2500
•2800 6
o2800B
A •000 0
43673
12 -02 -80
3 6570.
6,0)
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR
N S E W
SET BACKS
TYPE OF WORK
FINAL INSPECTION:
DATE REMARKS: