1980, 02-01 Permit: 80-1068 Fire Damage RemodelPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS ��
1. . i5
L T BLOCK SUBDIVISION
2, s a /7/ 41:y► ,2,k4-4,(141,
PHONE
3
#46W.:Z
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S 14,57A3 —01 7,5—‘
A -d7 6- 431.X2 VER/DALE »E J ¢ TS
.2ND ADD/T/OA!
ADDRESS
CONTRACT4. T99R 4e.ta
ADDRESS
—7/.39.2Q ?-#441,44.4-, _)1112,44Al—e—
DESIGNER
5,
ZIP
99z/G
Required Set Backs iiin�(F�geGtP'7! �Qifi:�.(/'cc.iJ�-
North SEast West
PHONE
ZIP
99.266
Size of Parcel Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Type Const.
Occupancy
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
�Split L vel Rancher
11/A
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
D AD'N. ❑ RPL. ❑ MVE.
❑ MECH.
OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
DRM.H. P.Ze-, ,41 "
8 DESCRIBE WORK} 3,�r� [� lC IA l
c -!� ,( to ur- — �'P. `'1i' %VN 'eSEWE
U✓AL ATION Source GAS ELECTRIC WATER SEWED
��(6 of
9, 2„QQl Utilities
Req'd.
Rec'd.
Not Req'd.
X_
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.
DATE Z--//-Bre) SI GNATUR E (17) ` .4—
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
—// — 8U
DATE OFFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building id
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
't- /068
DATE .2- 11- g`l
02* * 1 0.00
* 10,00
* 1 0.006
E *0.00 U
10672
02-11-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'02`--11"1-80 1O6.8 *laa,o°j
RECORD OF INSPECTIONS
Final Inspection
DA Hi REMARKS I NSP ECT ED BY
4
MI6
1-9(./