1980, 09-09 Permit: 80-9859 ResidencePLAN 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 3 COPIES
JOB .gDDRESS
1. IS( r 12I
LOT
2 I'
owr��
3. AO__
BLOCK
l7•
SUED VI ION
4-I IGNI ►� ; t\J leo o
I. f5>4.9( 1 -96\K
ESS
I. -2I I I�
RHONE
—7a2
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S Ip 5+I ., 0-7I
Actual Set Backs in Feet
North (South
East
(West
CONTRACTOR
4' ADDRESS
PHONE
ZIP
Size of Parcel
liCA212o
Type Const.
Zone lassiflcation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
O PLMB.
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8 I2
VALUATION
9.
(\/� I� J o1�•1f L -�-`� I I
SOURCE GRS ELECTRIC WATER SEWER
OF
UTILITIES
Enum. Dist.
Location (Area)
Ownership
Public 0 Private ❑
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 lo w regulating construc .r the
performance of construction. SEE REVERSE SIDE FOR REQUIRED (NSP I)NS
DATE OF APPLICATION SIGNATURE OF AJ
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning .
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
k6f,m4ock. "r- o� II
or 5l
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERM( f NUMt3`ER
cc-) •9857
02* *12.00
*1200 ro
98582
09-09-80
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
019, 0V-81`01
DATE ISSUED
985,9`x,
PERMIT NO. TOTAL