1980, 09-11 Permit: 80B-0028 RemodelPLAN NUMBER
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
JOB ADDRESS
LOT
2./l:)
O N
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
,LOT /a B :-/c 5U43
r"F rA'Ac =Ts i 7— zo rREivrw€en aRC/1M'1
C'NTRACTOR
E1. RESS
DESIGNER
5' ADDRESS
PHONE
ZIP
Type Const.
r Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
DESCRIBE WO
�¢ VALUATION
aO
ZIP
TO
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ M E C H D O L J OTHER
K /.4f . Jr
GAS ELECTRIC
SOURCE
OF
UTILITIES
WATER
SEWER
No. Baths
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
No. of Dwellings
Req'd. Rec'd.
Location (Area)
Ownership
Public ❑ Private 14
USE CODE
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 9 —�` '6 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Plannirrg
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu. ding Tech ician /►
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
g;
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 6 —�
r F ERMIT NUMBER
02* *6800
*6800 5
*6aoo
A *0,00
282
09 -11 -80
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
9,-11 810 2.) r;
DATE ISSUED PERMIT NO.
*68.0.02 —
TOTAL