1980, 01-30 Permit: 80-727 ResidencePLAN 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 4 COPIES
1.
2.
JOB ADDRESS
Lc r J LOt SUED V SION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3. J&. �J'T
ADDRESS „„,,��
(/ '7/%5- : 4 `e' ',"�' ,2-
CONTRACTOR
4.
ADD ESS
DESIGNER
5. ADDRESS
PHONE
53%57-gad- 7
PARCELMBER/S
N. 8D S. 6-41 1E. y 7' TRAeT /oS
P1A7 t.0 #5.57- ARMS /RR TRACTS
ZIP
99zo-Z
PHONE
ZIP
Required Set Backs in Feet
North 'South
East 'West
Size of Parcel
gdX /47
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuatio Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
k
TYPE
7. OF
WORK
❑ NEy$ 0 ALT. 0 AD'N. 0 RPL.
❑ BLD. 0 PLMB. ❑ MECH. 0 M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
/
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
SCRIBE WORK •
8. OA 141/1AeL
ALUATION Source
of
Utilities
GA
a �i/) (79--351' ®,�u. ua;2%)
ELE TRIC WATER S WER
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. T. granting of a permit does not presume
to give authority to violate or cancel the provisions of any other stat local law regul ting construct. or the
performance of construction.
DATE - gD
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
//fit/6D
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
/_3/ -?D
SPECIAL CONDITIONS:
71-gA-°-
DATE OFFICIA
n000rls/[n MD IQQI IA MCC
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
gQ-7Z7
DATE / .3G—Ed
ll. '7
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
inicr�s ,^Tf1R