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1980, 03-03 Permit: 80-1683 Addition
PLAN NUMBER •�_t_ APPLICATIN/PERMIT SPOKANE COUNTY—•.FEUILD G CODES DEPARTMENT NORTH 811 JEFFERSOt / SPOKANE, WASHINGTON 99260 / (509) 456-3675 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 1. JOB ADDRESS C. 3I rNIIV,1,-roj4 LIt ON 2. LOT• BI�/m/OsC K' SUBDIV IRIIb V1V—, 1v I ILJ COO OWNER III Irn�l1j�� 3 IEoe5—r 0. HoLML ADDRESS f ' CO��1'ilQQ l`i'`a��ZIrJ�-rdl'�I 4. LEGAL DESCRIPTION — SEE ATTACHED 42 E -176 -2 - PARCEL NUMBER/S 18544 1419 -772-0G PHONE ADDRESS ZIP DESIGNER 5. ADDRESS PHONE ZIP Required Set Backs In Feet North 2° 'South East (West Size f arcel Zone Classifi do x 90 Rrz' 1�. I�oMt Type Const. Occupancy Sprinkleretl ❑Ves ❑No 0 Req'd. ValluationfL ge O©Builtling ea in Sq. Ft. DyJr� Area 'Basement Area Garage Area Storage CHANGE OF USE FROM 6. TO Split Entry Split Level Rancher 7. TYPE OF WORK Ili NEW 0 ALT. BLD. ❑ PLMB L7AD N. 0 MECH ❑ RPL. ❑ M.H. 0 MVE. ❑ POOL ❑ OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE of EXEMPTION Req'd. Recd. Not Req'd. 8. DASpb�� 'Co �IIJ41L� VALUATION 5o rce GAS LECTRIC of � 9. Utilities 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 constrr%ction. DATE 'i- /c,0.- 8-0 SIGNATURE aca4-4/nLL+ /tel • DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning , Fire M. 'she Co. Engineer Utilities Zone Clearance SEPA Checklist HOME OWNER'S WARRANTY YES NO SPECIAL CONDITIONS: k(`GA-i- moI^ Pukt4s APPROVER � WM� DATE 3. -3. -SID OFFICIAL 411dd/ •igSij`✓/Mz' APPROVED FOR ISSUANCE FEES COLLECTED Single $�(Q Building Plumbing Mech. Plan Check SEPA Mobile Home Other (Specify) TOTAL DATE rO- PERMITSJMBER r'%— /1083 02* *9800 *9800 *98008 E *Q00 147.91 02=25=80 1 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. t3.ic0'3i; 8TO: 16&3'z ';''*'98,010.• 0: O COU W 0