1980, 12-01 Permit: 80B-4320 MHPLAN NUMBE- - J\
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
.1108 ADDRESS
1. ' 43, I I
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
w-J-(v\l oo n c i7,q-}p• tz-r7
3
ADD ESS
CONT RACTyIZ
4.
rvL/ 1,L~o
PHON
ZIP
PARCEL NUMBER/S O2 4.2. ` +704-
1001
x4 -
100t of IJ Lo cr 6 • i3 0 r
-r-i-
Actual Set Backs in Feet
North o 'South
East 'West "l
PHONE
Size of Parcel
100..?c13-3—
Zone Classification
ADDRESS
ZIP
Type onst.
VN
Occupancy
� 3
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
t d
ZIP
CHANGE OF USE FROM
6.
7.
TYPE
OF
WORK
ZIEW 0 ALT.
❑ PLMB.
0 BLD.
TO
M in Floor
7Bv
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
0 AD'N.
0 MECH.
❑ RPL. ❑ MVE.
0 OTHER
I.M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Fj.eq'd.
DESCRIBE WORK
8.
(I°1—x 70)
Enum. Dist.
Location (Area)
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
sjU
Ownership �n
Public ❑ Private {.�
USE CODE
9. loi 000
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 /CD (�%�
SPECIAL APPROVALS
NAME DATE
Env. Health
/9‘4e/f,
i
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
f•1661°ri,"1] I rd lop »1 fit IJT K661.
x/707• ;
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 $ 7
PERT 1'T N;,L4SBER-
80$
07* *50.00
*50.00
*5.0.006
A *000 8
431.92
12-01-80
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
121k'e
DATE ISSUED PERMIT NO. TOTAL
43.202 *5Oa. .
L6 1-1-AvIC
1001 .0-r L1. 2-X7' 137-I
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