1980, 03-04 Permit: 80-1761 ResidencePLAN NUMBER
f12-51/
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING tODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
3 10.
LOT BLOCK
2. /
Sc. aic Coader-
SUBDIVISIION
IYl1b140,vft F/Qfr- RDD/ti
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
�t R, a,
9r R -n o c -
ADDRESS
.sem
AV
PHONE
9. —1/022—
ZIP
99A0 4
PARCEL NUMBER/S
pocnotJ o F Tr 33n// - 9ov3
Required SetBacksin Feet
North 34 ISoutMZ,,C
East J (West e'er
4.
CONTRACTOR
SI, wit,
PHONE
ADDRESS
ZIP
Size f P rc - A.4090k7
/Qr. ad -r
- E
a� /3cu,o
s
Occupancy
R--3
Type Const.
*it V -N
Zone Classification
51N6CFr FA'MtL.y Kea
Sprinklered
Oyes ;Rho ❑ Req'd.
DESIGNER
6' ADDRESS
PHONE
ZIP
CHANGE OF USE FROM
6.
TO
Valu on
of 100
DWL AYeaBasement Area Garage Area
IZ , 11-701 F LH 2
Split Entry S Ili Level
Building Area in Sq. Ft.
Storage
en cher
TYPE
7. OF
WORK
p NEW
XB LD.
❑ ALT. 0 AD N. 0 RPL. 0 MVE.
❑ PLMB. ❑ MECH: 0 M.H. ' 0 POOL
0 OTHER
No. Baths
R.
No. Floors
No. Rooms
R er`Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd. -
Not Req'd.
DESCRIBE WORK
8'S/A/6/4C- F4MI k1 Pg. ioetict
VALUATION Source
of
Ut it iues
9. 7S _ gaV.
tOn,i d7RLt ATT- 6,q,CKlGGf..
GAS
ELECTRIC
/it/t4ao .
WATER
44inoti L.
SEWER
cv
I hereby certify that I have read and examined this applica ion and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correc . 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.
DATE 2 -moo -Sao SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
ym
Fire Marshall
SPECIAL CONDITIONS:
ets/ M A'P 'TP
Rik/ got -
r, k
r✓.
Zone Clearance
SEPA Checklist
PL#04-i .---7�
DAT EZr to OFFI CI ALC/LeStis.ad �r t7tar7A/tr /
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
aae
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 7-4C)
PERMIT NUMBER
$D-/70/
DATE -3 - 4-e0
02* *28t6.00
428;6.00
*28G006
E *Q00 a
17602
03.=04'-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES VERMIT.
0 3.k- 0' 4c- i8''01
1/61= 4286,002p'
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