1980, 12-10 Permit: 80B-4692 ResidencePLAN
NUMBER
J
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
OT BLOCK
2. E
2.
SUBDIVISION
t�.No6)Ern n T �t�rraT -r
OWNER
3 M1{Af.St.
ADDRESS
C.?• �s�
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
t + K
CONTRACTOR
Ia V)4
4- ADDRESS
AmF
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
E1'NEW ❑ ALT.
LY BLD. ❑ PLMB.
ZIP
Z.1
PHONE
ZIP
PHONE
ZI P
TO
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Actual Set Backs in Feet
North (South S!j
East
(West ",,C,04'
Size of Parcel
t1Z14._ t lrC`
Type Const.
V 'Pi
aluation
74, 41-43e-'
Occupancy
R.-3
Main Floor
DESCRIBE WORK
8 ,e"c„,�� F�JWICc.
VALUATION SOURCE
r-74 400 UTILITIES
OF
Et15CE
GAS
ELECTRIC
WATER
SEVyE R
Upper Floors
Area of Decks
3 0 1dtvli coy
No. Baths
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
2-3
Garage Area
Finished Basement
Storage
Unfin. Basement
CERTIFICATE
of EXEMPTION
Enum. Dist. Location (Area)
Ownership
Public ❑ Private
, 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 APPL' ,ATION /2 — A
SIGNATURE OF APPLICANT G`L�[+t�-/ it)
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
n
i2 2
"PTannin
Fire Marshall
1";/7/:
Plans Examiner
SEPA Checklist
Building Technician
.- .tel "7—
</ie 2
AC21:el *=011/2/P:1
);-0
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
No. ofDwellings
1
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$
44),
TOTAL $ -�
'RMIT NUMBER
02* ;*35800
'*358.Go
*358:006
*0,00
457.7R.
12;-08-80
s 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1,21 1,8 81 469.2` ' *358.00f
DATE ISSUED PERMIT NO. TOTAL
H
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