1980, 06-13 Permit: M80-5790 ACPLAN 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 4 COPIES
ADDRESS
1. JOB 2,5'/5-- ,i67:4 / A2.0
SUBDIVISION
LOT
BLOCK
LEGAL DESCRIPTION — SEE ATTACHED
2.
OWNER A�
3. &lig
�' %l
rt/ 2-57 y g.Ci.19
C gNTRACTOR +� .2
4. ADDRESS
PARCEL NUMBER/S
PHONE
�1�%L32.--
Ze./�<-4�%�
Required Set Backs in Feet
North 'South East (West
PHONE
Size of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. 'MECH: ❑ M.H. ❑ POOL
El OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
87/1/J77 G �EA/A,/ /9-17:2/i f4r/e
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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.
DATE fo -12-
SIGNATU
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
HOME OWNER'S WARRANTY
YES Li
NO
SPECIAL CONDITIONS:
DATE ID//3ll !JV OFFICIAL
ifiiii APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /IZei
1 1
PERMIT NUMBER
0
DATE
04* *7,00
*7.00 r
*7,006
E *0.00
57892
06-13-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS ECOMVS A PERMIT.
—01:3.-8 0 5 7 9, 0 z
*7.00°