1980, 11-18 Permit: 80B-3913 PipingPLAN NUMBER
ti
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
JOB ADDRESS,3 /5 04,444 -
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
. OW
3.
ADD
BLOCK
SUBDIVISION
PARCEL NUMBER/S
ER
-GLO 1
R US (era --
PHONE
9 -28' -0)0 -
ZIP
RACTLOR ^-N`r, e-10
ADDRE 5O S r
�- /L4r✓lQ��
PHONE
9 Z > 57fl
ZIP
"9z€,f6'
5.
DESIGNER
PHONE
ADDRESS
ZIP
Required Set Backs in Feet
North 'South East (West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area to Sq. Ft.
DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
Ei W 0 ALT. 0�AD N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. 1N MECH: 0 M.H. 0 POOL
O OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
/Jt-Lti�/JLr Ki
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify than( 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.
DATE g—/7 - Fa
SIGNATUR
SPECIAL APPROVALS •
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
za-
7-' 7. A
DATE /08OFFICIAL
®, APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL
$4,60
1
PERMIT NUMBER
DATE
0'4* *4.00
*4,00
*4006
A *0.00
391.2
11=18-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A.P.ERMIT.
1.11.11319.0 g•