1980, 11-12 Permit: 80B-3572 Repair, RoofingPLAN NUMBER
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///721�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
1-7
LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION rot,1a4C, KM1,1^111-`(
11 1V2 J {-4aM 6 0111 ONI
PHONE
ZIP
OWNER
3 I- P2)1
ADD ADDRESS
N , 2 17 —i.
PARCEL NUMBER/S
O 7 + - l 7()
oc°NI CVN 5 �/I �ccBtJ , -r te,
17 7IIIo g nIV. .B�i��J
Actual Set Backs in Feet/
North 'South lEast 'West
CONTRA TOR
{? I� IJ�r . CONK
4' ADDRESS lT• 571,2_ I5r
PHONE
+87—'53
DESIGNER
5. ADDRESS
PHONE��
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
0NEW ErA LT. 0 AD'N. 0 RPL. ❑ MVE.
LJ BLD. 0 PLMB. 0 MECH. 0 M.H. ❑ POOL.
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DES"RIBE WORK
VALUAION SOURCE GAS ELEC—RIC WATER
9. I ODQL F
UTILITIES
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not R7Q'd.
SEWER
Ownership
Public 0 Private
v, 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 //"./Z PO
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Plans Examiner
SEPA Checklist
Buil g T ician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $ I
Building 110
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
i05 - 3572—
02* *11000
*1100C to -
*11Q006
R *000
357.12
11-12-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,11 t,1'2 -,'8 t 3' 5 7.2 I *1:1 a o o e -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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