1980, 09-12 Permit: 80B-103 Repair Fire DamagePLAN NUMCER
9h o
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
1. e. /LC3/c
LOT
2. S
BLOCK SUBDIVISION
i4/ ",e,q (36,4e, Rel/1/ C/1 1400.0..
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3./M
ADDRESS
6. / eo /C 3(46x -eve -
,CONTRACTOR
a &VTc c.
ADDRESS
6 :.5 7/ z / : T
4.
9/ /C
15=73
PHONE
948--4/'lo‘,"/
PARCEL NUMBER/S
C>96y' 1-/y.3O
ZI P
9yze)c
Actual Set Backs in Feet
North 'South
East 'West
M sRTrf WCS7 %Nc,
PHONE
S3 -£7.37
Size of Parcel
86 5c /39
Zone Classification
<SC1t3.
ZIP
94�c�
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
ADDRESS
PHONE
Valuation
/ 5, oan
Building Area in Sq. Ft.
i9
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
VALT. ❑ AD'N.
❑ PLMB. ❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8..f EP4/ Fee
VALUATION
911e/ Or -.2C)
/17,4,47 CI: Tv Roos" .5/ 65/1.- /i€;
SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
Enum. Dist.
Location (Area)
SEWER
Ownership
Public ❑ Private LrJ
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 INSPECTION
DATE OF APPLICATION _ ./2—r
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildin Technician
SPECIAL CONDITIONS:
Co/r.1•:75. )7o,•11 c�OF/iI/gy
6x .s/.O a r/ 5
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building Si/b.bf7
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ I/O, oc3
PERMIT NUMBER
8c - /co.a
02* *110,00
* 110,00
* 1 1 0.006
A *0,00 ER
102
09-12-80
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O 9:r;1 2 `'8;0 1 0. 3 ° *1 1 O. 0 0
DATE ISSUED PERMIT NO. TOTAL