1980, 05-23 Permit: 80-4968 Residence(PLAN 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.
JOB ADDRESS
LOT
2. /Z
BLOCK
•UBDIj imc u ofn
LEGAL DESCRIPTION — SEE ATTACHED
3
OWNER 4
ADDRESS
ow z.CL G .,,A./Q `a l A a0
4aUt. 13 414•3
CONTRACTOR
0-`mD
4" ADDRESS
PHONE
q ,—a44(0
PARCEL NUMBER/S a ( N a.13O( aT11
ZIP
9qb
Actual Set B,acks in Feet
North<5 'South 6c,
East
West 3.
PHONE
Size of Parcel,
ZIP
Type Const. Occupancy
/ I Zane C=h tion
��iLLfi
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
V Juation
ZIP
Main Aldor
Building Area in S5. Ft.
Floors GaragbArea
Finished Basement
3 7
Upper
CHANGE OF USE FROM
6.
TO
Area of Decks
Storage
Unfin. Basement
g,/
TYPE
7, OF
WORK
[I NEW
❑ BLD.
O ALT.
O PLMB.
❑ AD N.
❑ MECH.
❑ RPL.
❑ M.H.
O MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8' 4)./AL-4-e-194.(e..1_, It(:( -21
ALUATION SOURCE GAS
OF ELECTRIC
UTILITIES
s.5v o d6-
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 - 7
E4WEER
Enum. Dist.
ILocation (Area)
Ownership
Public ❑ Private
USE CODE
DATE OF APPLICATION c.3 --a3 OZ) SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAM— DATE
Env. Health
P. KIeot/VII 2,�/go
PIan ning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui Id inq Te nicia
SPECIAL CONDITIONS:
/
Y,��J Gti7it.(/L 1UL
"APPROACH PERMIT REQUIRED"
Contact County Engineer's Office
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Buildin/
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
ie 64
r-
PERN,IT '':UMBER
00"4.960
02* *295.00
*29500
*29500
E *0.00
4962
05-23-80
2 6479.
496.82
05-23-80
6479.
co
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
co - 4���
PERMIT NO. TOTAL
177.H ✓
3.2 I
PRO PED
N