1980, 12-29 Permit: 80B-5250 SidingPLAN NUMBER
J
/�y��� 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 'r Road_
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
2.
OWNER
3. Oa 'Ana Jd l t rP,y-
A DRESS �_^ -/
fi�� Blame 62 L
PHONE
-6-5/9
PARCEL NUMBER/S 2Z. , `_ c `.prN at= NW�4
..""P NeV4-' S. 13,z' Df t .to ,'OF C•330'
ZIPS 7,72../6,
Actual Set Backs in Feet
North 'South
East 'West
CONTRACTOR
MC [/ • 4(6791.61_3
4. ADDRESS
4r/ 3/v/,,
PHONE
Size of Parcel 1 Zone Classification
oJhe had_
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5
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.
❑ PLMB.
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
1LJ OTHER
tee pt- J'
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
DESCRIBE )00RK
/]J
VALUATION SOURCE
OF
UTILITIES
ar0q.307.t/
O
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 t
performance of construction.//! SEE REVERSE{SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION lg/�/D SIGNATURE OF APPLICANT
L
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technic]
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERAB
1
PERMIT EXPIRES ONE YEAR FROM DATE 0 SUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$ 3f, 00
TOTAL $ ..-617100
PERMIT NUMBER
8e13-.52.� IJ
02* *3800
* 3800
* 38005
A *0.00 0
524,9g
12-29-80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12429.4
DATE ISSUED
525.011'- 38.00T F2
PERMIT NO. TOTAL