1980, 02-01 Permit: 80-1027 Fire DamagePLAN NUMBER
JOB ADDRESS
�. G
LCFT I BLOC
2 OWNER
3.
ADDRESS
CONTR, R CT.OF
4. ADDRESS e
DESIGNER
5. ADDRESS
CHANGE OF l:
6. '
TYPE ❑ NEW
7, OF
WORK ❑ BLD.
DE,�,CRIBE WOAI<
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
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
PARCEL NUMBER/S Q& 5+ -J :602
J
PHONE
ZIP
Required Set Backs in Feet
yy
��oLQ
North South
East West
'
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
_ Sprinklered
-F c -7❑Yes
❑No ❑ Req'd.
PHONE'
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area
Basement Area
Garage Area
Storage
FROM
TO
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
1-1 ALT.
E]AD'N. ❑ RPL. 11MVE.
OTHER
ElPLMB.
1-1MECH: 1:1M.H. ❑POOL _ n
/Pe.....��0
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Re.
FEES COLLECTED
VALUATION -, / Source GAS `ELECTRIC WATER SEWER
9, �` Utilities
Single $
I hereby certify that I have read and examined this application and have read -the. "NOTICE" provisions included - A oG
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building
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 10 law regulating c struction or the
performance of construction. o Plumbing
DATE Z— Y—`QQ SIGNATUREU::K Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. fj�'� 'T ��4i' �D`LQ+(a� Plan Check
Env. Health
U ¢•tY SEPA
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist 2— 5-ge
DATE OFFICIAI,iJ
APPROVED FOR ISSUANCE
Mobile Home
Other (Specify)
s�G Q�
TOTAL $ J o
PERMIT NUMBER
0-;�-7
DATE
02* *38.00
*3&0,0 N
*3gpp
B *Q00
1026
02-1.1,-80
;? 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0 2,11':.1.,7 8'' 0 10 2 7 z
*38.0.Oa.�
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