1980, 09-30 Permit: 80B-1138 DamperPLAN 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 3 COPIES
1.
2.
3
JOB ADDRESS r /del
f/oW F 013
LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION
OWNER _
Sa<Jt /- Note/14 _2
ADDRESS X
Mal ;I- 3 5 d4ie 14/1/CONTRACTORr `
M/ L i Lf:'i / ie(/} A/ % Cf r G /e /y
4' ADDRESS /
f' /P1-- 7/U"I. o 1,'a
J /P
PHONE
9? -Yd s,2
PARCEL NUMBERS
ZIP
Actual Set Backs in Feet
North 'South
East
(West
DESIGNER
5. ADDRESS
PHONE
9./A 12/ad
z11
97vZ //
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
7.
TYPE
OF
WORK
❑ NEW
0 BLD.
❑ ALT.
O PLMB.
❑ AD N.
O MECH.
❑ RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WO,RK
VALUATION
9.
I /
SOURCE GAS
OF
UTILITIES
f4 rk9— 5" es�%f// �-.-�
ELECT R le WATER SEWER
Enum. Dist.
Location (Area)
Ownership
Public 0 Private 0
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
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. 3 Uv
Plan Chick
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
'8C=3 l38
04* *7.00
*7.00
*7.00
A *000 53
11292
09-30-80
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i9—‘3'a-8 i;'
DATE ISSUED
113,8
PERMIT NO.
*7.G 0
TOTAL