1980, 09-25 Permit: 80B-900 InsertPLAN 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 ADDRESS
e-• /30/9 BGo s Selo
1.
LOT
2.
3.
4.
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
5.
OWNER
01/ �C/ffCC66k
PHONE
9 8 —37,a, 3
PARCEL NUMBER/S
ADDRESS
e, /3 0/ ct GGSSts f
CONTRACTOR
LcJfl•<6--/i'oc4.s S.74 '
!7 /STi2.
PHONE
Actual Set Backs in Feet
North 'South
Size of Parcel
East
'West
Zone Classification
ADDRESS
66oS" c . SP2 uE
DESIGNER
ZIP
9147'Z'Or-
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation'
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
7.
TYPE
OF
WORK
E(NEW ❑ ALT.
❑ BLD. 0 PLMB.
0 AD'N. 0 RPL. 0 MVE.
Yr/MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'cl.
Not Req'd.
DESCRIBE WORK
8. 1000 Z) 3 c ,p,77 rt;
VALUATION
9.
SOURCE
OF
UTILITIES
Enum. Dist.
/rLSE/2
Location (Area)
GAS
ELECTRIC
WATE R
SEWER
Ownership
Public ❑ Private 0
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 ' r>.ulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPE IONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utii ties
Plans Examiner
SEPA Checklist
Building Technician
�rrir �' r
V O
SIGNATURE OF APPLICA
SPECIAL CONDITIONS:
.r .
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. UO
PERMIT NUMBER
So3 �Ior�
04* *7.00
*7.00
*7.006
A *000 0
89.98
09-25-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8:0 90.05
DATE ISSUED PERMIT NO.
*7.00°
TOTAL
2
O
W
—J
U.