1980, 06-04 Permit: 80-5388 AdditionAPPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
• NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT:
COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3COPIES
JOB ADDRESS
1 LOT BLOCK1SU tDIVISIO
2.
Oil..C_V•_C)..A...CO. CW42 nnA.,.1 CCLATIO.
OWNER(
--.\
• 1)-Q-�c r l� �.
1 C> Q r S1
ADDRESS
c�vv`a > QQ rcxJ-
CONTRACTOR
ADDRESS •
DESIGNER
5' ADDRESS -
PHONE
q a.4
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S b�GJ�3-3c� OQ
19„Q.. IJ, 3 • as' 11,.0 e . Ila, et, `Lwd.
4t73 of) OSA-.o: CW•42 . Ct.O CD Q.
PHONE
ay -eta
ZIP
99 an3
Actual Set Backs in Feet
�RI
North ' `) South East R
Size of Parcel Zone Classification
CIO X
Occupancy
Type Const.
•
West
Sprinklered '
❑Yes ❑No 0 Req'd.
PHONE
Vuation C9� Buliding Area in Sq.
ZIP
G kik!
in ri600r
bralo`p
CHANGE OF USE FROM
6. •
TO
of D
Area gck
a5c�
Uppers Garage Area
s Finished Basement
Storage
TYPE
7. OF
WORK
❑{ NEW
ql BLD.
❑ ALT.
❑ PLMB.
DESCRIBE WORK
8.
VALUATI(9N,
s. eDIlyyr'0 UTILITIES
b`x1b'
SO CE
'tel AD N. 0 RPL. 0 MVE.
0 MECH. 0 M.H. 0 POOL
iVDCJv _ C-AK_Q�0 r
0 OTHER
No. Baths
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
Req'd.
UnfinBasement
No. of Dw%lings
Recd.
Not Req'd.
Enum. Dist. !Location (Area) r
GAS ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
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 INSPECTIONS
DATE OF APPLICATION C1 � — SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env
Co. Engineer
Utilities
Plans Examiner
t 'TOM PO. 'TLEAvki- '1 lOn
SEPA Checklist
ng , echnician
SPECIAL CONDITIONS: JAS d�6
�Gdv a3-01 k I - rJ Com—
gta..*a.6 lc. -
�� rAr� S T� 2 NEr�
y -6 7-90
VikKvAcKPe,rev- K
G IA PERMIT IS NONTRANSFERABLE
E.y
FEES COLLECTED
Single $
�uilding /
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NU SE4
80 M 8r
53'
02'*
*6200
*62.00
*62006
*0.00
53'a72
0 42- 8 0
2 6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,s ip.I.44►`18; 0
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE. ISSUED
.)18.:8'2
PERMIT NO.
'6 2.0 0 a. I
TOTAL