1980, 11-04 Permit: 80B-3177 ResidencePLAN 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
4.
JOB ADDRESS
LOT B CK
7 ,-
SUBDIVISION
-f� 9 Aal fi I
OWNER
Wirli') 1,1 ce,tr,
AD RESS
r!f74-I
CONTRACTOR
ADDRESS
PNON
i.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S � �4I - 2 7o CroKi J)
Z9�ft
PHONE
Actual Set Backs in Fee
North 'South
East 'West
ZIP
Size of Parcel
16--7 I
Type Const.
Zone C as ification
rn4
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuatign ,
Building Area in$q. Ft.
ZIP
CHANGE OF USE FROM
6.
TO
Mfin Floor
TYPE
7. OF
WORK
'NEW ❑ ALT.
I"BLD. ❑ PLMB.
El AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Upper Floors
ea of cks
Ij4 �
No. Baths
Finished B
G rage rea
v
Bas ent
Storage
Unfin. Basement
No. Stories
No. oms
No. of pwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Notyd.
8.
DESCRIBE WORK
Lt AMS L7 �/ ciE
VALUATION SOURCE GAS ELECTRIC
OF ��''WAT�R
�v''��iAt-TQQ-�r
9. UTILITIES
Enum. Dist.
SEWER
Ownership
Public ❑ Private
Location (Area)
X6SE 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 n. presume
to give authority to violate or cancel the provisions of any other state or local law regulating construion or t
performance of construction. S E REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
Q
SPECIAL APPROVALS
NAME DATE
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
S ECIAL CONDITIONS:
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
ltl mbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
[rrv1Ir i.UMBER
go,a-- %77
02*
A
*26000
*260.00
*260.008
*0.00
296.6-2
1'0-30-80
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,1;11 t, �! �8 0
DATE ISSUED PERMIT NO. TOTAL
3,17.7g *2'6100Z0
c
L'
.,i
4(
�Q� 7
,8/eck 2 -
50,01-f(4 04b4,4s