1980, 03-11 Permit: 80-2078 ResidencePLAN NUM _
-53
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
JOBADDRESS CC%% 'n
BLOCK ABDG.7 ON
r r4 K >
2.
3.
LOT
4,sc0
LEGAL DESCRIPTION — SEE ATTACHED
OwM
PH NE
i7e3v6
PARCEL NUMBER/S
00/ ( Pc9,en4h
e,FJ
ADDRESS
.
CONTRACTOR3A /G.� < RA~I /��
S1'1 r
4' ADDRESS
ZIP
1900
Required Set
tBacks in Feet
North LV ISo
East
(West ;5
PHONE
Size of Parcel
sd )SSG
Zone Classificati n
! c—
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes DNo ❑ Req'd.
5.
DESIGNER
PHONE
Valuation 700
v
Building Are in Sq. Ft.
ADDRESS
ZIP
Basement
rea) Garage Area
UAW -
Storage
CHANGE OF USE FROM
6.
TO
Split .Entry
0 Split Level
Rancher
TYPE
7. OF
WORK
IZY NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
'BLD. 0 PLMB. ❑ MECH: 0 M.H. 0 POOL
0 OTHER
Nol.ths
No. Floors
0
00m5
Rec. Room
ERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. � //../ C7 l
VALUATI ON
9.
GYIL j
IS/PEh4E
Source
of
Utilities
GAS
ELECTRIC
E 2GWATER
t-419i2-13 /-1 vE
C e-yrorll c.44.•
SEWER
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 on .truction.
DATE
DEPT.
SPECIAL APPROVALS
REQ'D.
REC'D.
SIGNATURE
Env. Health
Co. in
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
�I�L CLtPP<j� 6;14 irrc t--De,u-SS`r5 ,
WI Lc, Sg,— (-JP i3 /c. PL- • }SLP PA
l 12J LO i 043 pYc c2t Cf 4 /
T I,IG,
Mk. _ -(4//x'
4517 0-ifJNhFi€ ppJ. �-
�oan r,
MAI I, -co ownwl
DATE 3'i/''NI) OFFICIALfr
FEES COLLECTED
Single $
Building '2O I
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL �D14-e
TE T=I iii' UMBER
8U -2o7'
DATE
02* *20100
*201,00 m
*201 00
E *C 00
207.7
03-1 P-80
g. 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
(1 74,L'1 0 r.
* 2 0 1. 0 0
INCPFrTnR
518 sp.
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