1980, 02-14 Permit: 80-916 InspectPLAN NUMBER
imemimmo
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99280 / (509) 458-3875
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. .1. �11ilDR. ci.—suet/ CU—WM. RP.
O DIVISION
/yc
wNER
3, DDCN 5:9 HARN151-..
N�S11S BOL.*UA2 RO
▪ ONE
219=35613
pp 0TGR
4. �'RT%E
AD
DRESS
DESIGNER
S' ADDRESS
z111
6K1Ll(o
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMSER/S
3.5=z�
Raeulrag Sate,gs In Fml
Nprth 'South
Sim of Parcel
at !Wst
om clamnmuon
ZIP
Tome Const.
Oacuponcy
P HONE
Valuation
OYm ❑No Sprinkler.
R.a'a.
!lunging Arm In SR. Ft.
SIP
OWL Arm
Eaxm.nt Arm I Owe. Arm
CHANGE OP USE FROM f rO
0 ALT. �❑f ADM. 0 RPL. 0 MVE.
Ql
❑ PLIAS. [ MECH: ❑ M.H. 0 POOL
PE * i0 NEw
i. OF 0 BL
O.
O.
Split Entry
Spilt Leel
Rancher
0 OTHER
No. Baths
No. Floors
No. Rooms
ROC. Room
DESCRISE WORK
a INs-rlacr. Woo() siogE
Y _ IDN I
Souris
UtIIIINa
CERTIFICATE
of EXEMPTION
Ras d. Rat's of Rad'd.
OAS
ELECTRIC
WATER
SEWER
I hereby certify that 4 hou read and examined -this *pollution and have road the "NOTICE" provisions included
reverseon gide, and know this sante to be true and. correct. All provisions of laws and ordinances governing this
type of work will W complied with whether specified herein not. The granting of a permit does not presume
to give authority to violet. or Gnat the p I I ret of alnTother stetq'-locorliw regulating constructici or the
o wl rucdop
0A1 — SIGNATURE
SPECIAL APPROVALS
OEPT. REG'O.
Inv. Hmltn
Planning
FR. Maranon
00. Ln.Mmr
REVD.
Zona tnmrana
SPECIAL CONDITIONS:
FEES COLLECTED
Sirgl
Su/Mina
Plumb ni
Plan Cheek
SEPA
Mobilo Homs
Other (Specify
TOTAL S —AOC,
_ ERMIT NUMBER
/6
PALI-
7DO
9
WHEN MACHINE VALI0A TF n IN THIS SPACI
INSPECTION RECORD
OWNER
LOCATION
CONTRACTOR
TYPE OF WOi/
NSEW FINAL INSPECTION:
SET BACKS
DATE
REMARKS: j
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