1980, 04-21 Permit: 80-3702 AdditionPLAN 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 A DRESS
1. , ne *26 ok1
2.
LOT BLOC SUBDIVSIO
10141 442 A - /1/4101711:
IP 6
P ONE
3.
OWNER
i QtAb cA1(I +3C61
ADDRESS
¥— 7 15 f o rJ
C(3Na
4' ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
- 751 or do. -ISa' ✓13'54
ZIP .
Actual Set Backs in Feet
North 1-5 (South
Size of.Parcel
X /5
Type Const.
East (West
Occupancy
Zone Cla/Ca lo� I
Are/
u 0 ^
5 inklered
❑Yes ONo 0 Req'd.
5.
DESIGNER
PHONE
Valuat p 1 BulldIng Ared In$q. Ft.
ADDRESS
CHANGE 0F_')SE FROM
6.
TYPE
7. OF
WORK
ZIP
Main Floor
Upper Floors 1 Garage Area
','r
TO
Area of Decks
I, 900
Finished Basement
Unfin. Basement
O NEW 0 ALT. e AD N.
Yl BLD. 0 PLMB. 0 MECH.
0 RPL.
❑ M H.
❑ MVE.
0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not
Req'd.
v
8. DES oJjJORK
p�
VALUATION
9.
KJ Ato
-tI01.1 Cie x�-s�
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELVRIC
WATER-I
COM NI
SEWER
Ownership IA USE CODE
Public 0 Private
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 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
En
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Id ing
SPECIAL CONDITIONS:
1J0 rLALIC7 I'i mlJ'I I D
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT I' 13L
`6f - ?,-1 pea.
02* *29.50
*29.50 16
36242
04-1'7-80
e 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O'4ilfel!.;;VO! 3711.2.5
DATE ISSUED PERMIT NO.
*29.5'02
TOTAL
• I
I
1
r -.
1 1
t• r
I
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..-A
6
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