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1980, 09-04 Permit: 80-9651 Insert
PLAN 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 LOT 57€2 N BLOCK OWNER 3ivA.// 5 ADDRESS SUBDIVISION PHONE 92e -s7%7 LEGAL DESCRIPTION - SEE ATTACHED PARCEL NUMBER/S /V, Roc/ u A' CONTRACTOR 4. ADDRESS DESIGNER 5. ADDRESS CHANGE OF USE FROM 6. TYPE 7. OF WORK gNEW ❑ BLD. ❑ ALT. ❑ PLMB. ZIP 9c.��' `/ PHONE Actual Set Backs in Feet North (South East Wes ZIP PHONE ZIP TO ❑ AD'N. Of MECH. ❑ RPL, ❑ M.H. ❑ MVE. ❑ POOL ❑ OTHER Size of Parcel Zone Classification Type Const. Occupancy Sprinklered Oyes ❑No ❑ Req'd. Valuation Main Floor I Upper Floors DESCRIBE WORK r/eE Ca /1I.s /e VALUATION 9. SOURCE OF UTILITIES GAS ELECTRIC WATER SEWER Building Area in Sq. Ft. Garage Area Area of Decks Finished Basement No. Baths CERTIFICATE of EXEMPTION Enum. Dist. Storage 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 local law regulating construction or the performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS DATE OF APPLICATION 9/"i / i a SIGNATURE OF APPLICANT. SPECIAL 'APPROVALS SPECIAL CONDITIONS: NAME DATE Env. Health Planning Fire Marshall Co. Engineer Utilities Plans Examiner SEPA Checklist $3 echnici PERMIT IS NONTRANSFERABLE PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE FEES COLLECTED Single $ Building Plumbing Mech. Yom 7, ©C Plan Check SEPA Mobile Home Other (Specify) TOTAL $7Q© A9 PERMIT NUMBER rho - 96,5/ 04* *700 *7:00 965,02 09-04-80 6.479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 0 91- 0 4"-'81101 DATE ISSUED 965,1 PERMIT NO. 0. TOTAL FIIF MP)/