1980, 12-05 Permit: 80B-4515 DamperPLAN NUMBER
(b )
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. L_oT
2.
BLOCK
id
LL AL DESCRIPTION - SEE ATTACHED
SUBDIVISION
PARCEL NUMBER/S
OW ER
3 Ti/.✓ Oae rt'. -5%
ADDRESS
E i 00/ 5-- Hv/, --- - /4 5 -ne, .��w e / (ib
C NTRACTOR /
�� Ci trl.� /// J ( y HPK/^'C9 F(, [ I'r/G
4' ADDRESS ' /
67,17/0 /i✓O'O •✓./ SjJO �Cr P,
DESIGNER ✓
6' ADDRESS
PHONE
PHONE
9d- I-270
Actual Set Backs in Feet
North 'South
Size of Parcel
East
'West
Zone Classification
ZIP
99..2
Type Const.
Occupancy
Sprinklered
Dyes DNo 0 Req'd.
PHONE
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
Unf In. Basement
TYPE
7. OF
WORK
NEW
0 BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
6. MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Roc'd.
Not Req'd.
DESCRIBE WORK
8. s J'La. // G .Oart
VALUATION G'
9.
SOURCE
OF
UTILITIES
AS
ELECTRIC
WATER
SEWER
Enum. Dist.
Location (Area)
Ownership
Public 0 Private 0
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 INSPECTION
DATE OF APPLICATION /.' - Y - YL/
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
r NAME DATE
Env. Healt
fanning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
fi Sar?
,s 97 ✓ice,
11- rt
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
3. ea
47/14,-`F aiv
Plan @heck
SEPA
• Mobile Home
Other (Specify)
TOTAL $ 7 aer
•
PERMIT NUMBER
66 - r.5
04* *7.00
*7.00 n
*7.006
A *0.00
4'51.48
12-05'-80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE.ISSUED
4515'=
PERMIT NO.
*70O -
TOTAL