1980, 09-22 Permit: 80B-649 DamperPLAN 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
1.
JOB A0OR�E{jS(S/S �� "a /.1p��', VES
2.
LOT BLOCK 5 BDA^ -1 f Lt l.refi`s% -L.K G-� 4AFr�
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3. ZDRESS
4(1h s. , det -
"" /uC O c2o , c& za.
P% ' N CJ-ot,
PARCEL NUMBER/S
2751k a 2b03
Pc.7 6
Actual Set Backs In Feet
North 'South
East 'West
CFTRACTOR _/ t
4. 'f7/ l..Al.j4
DRESS
fl 7,o
DESIGNER
5' ADDRESS
PHONE
f.� aict
Size of Parcel 1 Zone Classification
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd.
Valuation 'Building Area In Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
TYPE
7. OF
WORK
0 NEW'''. 0 ALT. y❑AD N. 0 RPL. 0 MVE. /
0 BLD. 0 PLMB. L"J MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DE RISE W9RK
B VALUATION f�'c.'eKr) GAS
9.
SOURCE
OF
UTILITIES
Enum. Dist.
Location (Area)
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
1 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 / 0, SIGNATURE OF APPLICAN
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Englnee
Utilities
Plans Examiner
SEPA Check(
Bull • Ing Tech /clan
.1 ./ �Li.v
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
1
SEPA
Mobile Home
Other (Specify)
t� O h
TOTAL $ /
PERMIT /NUMBER U
Q —ea
04* *7.00
*7,00 N
*7.006
A *0.00
648g.
09-22-8.0
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09 -',2,7'.:.8;01
DATE ISSUED
614.9z tt'7.00a..
PERMIT NO. /T,OT-'
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