1980, 08-21 Permit: 80-8932 Residenced
PLAN NUMBER
'/c //�c'�
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
LT BLOCK (SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S .0/ r
OW
3.
ADDRESS
•2,r1 f /� 6 4- 4/1 V/
CONTRACTOR
f�f//
ADDRESS
4.
Pk-IONE
ZIP
q
PHONE
Actual Set Backs in Feet
North 7 7 ISout < East +% West
P.%
Siz of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
ZIP
Valuation
ai Floor
Building tp S Ft.
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basemen
TYPE
7. OF
WORK
ICT NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No.B the
NoStories
off+_
No. Roms
No. of pwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Fteq'd.
9.
DES BE WORK I /ece:e.-.6P--jZcte.
VALUATION SOURCE GAS E7RIC _WATER
OF
--/6 //� y�
UTILITIES t
Enum. Dist. 'Location (Area)
EWER
Ownership SE CODE
Public ❑ Private
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 8 `2C SIGNATURE OF APPLICANT/L'! / 6'' L2
SPECIAL APPROVALS
NP.ME DATE
Env. allltt
PI nning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building 0
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL $
PEjF fy1IT NUMBER
.02* *2;10.00
*2;1000 n
*2;10,006
E t*000
8866
08-2'0-80
6 4'7 9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0,
8',-.42 P qtY
89'3.25 *210.00212
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
-75 s