1980, 09-29 Permit: 80B-1040 InsertPLAN 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
1. 5' l4loeic
LOT 1 BLOCK
O NER n"YY�
3. l2(.Qi ?
DRESS
LEGAL DESCRIPTION - SEE ATTACHED
2. I
SUBDIVISI
PARCEL NUMBER/S
e,/446,6 -
CONTRACTOR
4. DC1.Q/YYLii
ADD,P26RESS
SI
DESIGNER
5' ADDRESS
PHONE
9 -81/2( 7
ZIP
Actual Set Backs in Feet
North 'South
East 'West
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes DNo ❑ Raq'd.
PHONE
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
TYPE
7. OF
WORK
D NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑q AO N.
MECH.
❑ RPL.
❑ M.H.
O MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
ofEXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE W RK
_ WATER
OF
9. UTILITIES
VALUATION SOURCE 9A5
ELECTRIC
Enum. Dist.
•
Location (Area)
SEWER
Ownership
Public D Private D
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 the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTI t_S
DATE OF APPLICATION 9-2 Co --e?SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:41111
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utllitl es
Plans Examiner
SEPA Checklls
B din
Te hnici
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
.Other (Specify)
1 04
QU
TOTAL $ 7.
PERMIT NUMBER
8013-io3D
04*
*7,00
*7.00 .N
1039
09-29'-80
2 6479.
r
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 ►.I
blghr2a9'?18;U)
DATE ISSUED
1'0 40 5 '*7.'0,0,°r2
PERMIT NO
TOTAL