1980, 06-02 Permit: 80-5205 Move Residence, Renewal of M5546PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT ,
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. C• 137o4 -
keRoy
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. i,�oLuE�-
ADDRESS
C 13104
CONTRACTOR
v\1E
ADDRESS
DESIGNER
4.
5.
S. Slcccry
PHONE Al
PARCELNUMBER/S w Cjo,scv 6F N. 412-.51 cD°
of TRgcT •37 , -'/4. 5. o F HeRoy
"we. --natronclocn) D -{N . o3S41- 66eeI-P..chwQa3
Akera.oy
ZIP
Actual Set Backs in Feet
North (South
East (West
PHONE
ZIP
Size of Parcel Zone Classification
40 X \ CZ A2\CuLT\AC2WC,
Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation Building Area In Sq. Ft.
t 0440
ADDRESS
ZIP
Main Floor
a60
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Lint in. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH.
❑ RPL. ❑MVE.
❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Res'd.
Not Req'd.
DESCRIBE WORK .
•
8. Reocwwt_ OF 144 S54Sr, — A10ONCa
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private wee
USE CODE
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 construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION !G — 2 — d"°
SIGNATURE OF APPLICANT4LIASte1
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Builtl gTechnician
SPECIAL CONDITIONS:
C,e,2<. 6F EtctnAPrt o w Errs -673 , 1..1/ pry.LC{(iv HC
-RE 4,....16:4-A3 q L
O F %or.A ATT ACHED
_p2Ze\tZ
er Cr C. C.Ctarze0
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA.
Mobile Home
taGN EWA,—
Other
WALOther (Specify)4•0°
TOTAL $4k-00
PERMIT NUMBER
C-7.17.
02* .*4800
*4800 ti
*4800
8 *Q00
52Q4R
06-02:-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
52:0,55
*48,00, _ -
PERMIT NO. TOTAL
a
C
LLI
U
LL