1980, 05-13 Permit: 80-4701 Move Residence, Renewal of M5062PLAN 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
JOB ADDRESS
M
2.
3.
4. ADDRESS
LOT BLOCK SUBDIVISION
OWNER I
re �� hd l
ADD ES
• -7--- x I If>
CONTRALTO
A
PHONE
I
() 1
PHt#NE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
East (West
Size of Parcel
1 7
Zone Classification
ZIP
Type Const.
Occupancy
DESIGNER
5. ADDRESS
PHONE
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
ORK
r
❑ NEW
ALT. 0 AD'N.
0 MECH.
0 PLMB.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not R,eq'd.
9.
IBE WORK
rsr:-1e�'-rJc
VALUATION SOURCE GAS ELECTRIC
OF
UTILITIES
Enum. Dist. I Location (Area)
WATER
SEWER
Ownership
Public 0 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 INSPECTION
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ding Technician,
SIGNATURE OF APPLI t'
PECIAL CONDITIONS:
ft51•1 n rel,' rJ 1 07
i I
II 2
II II v (C7C
01-2,u4l i'- ii r r ¢ l b
M ')
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
02*
* 9.00
* p00 t
* 900,
P *19.0
4700
03-13-80
0479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
-8.0
5,L23
DATE ISSUED
47 O.15
PERMIT NO.
*9.00a'�
TOTAL
>-
0 -
WHEN
a.