1980, 04-23 Permit: 80-3892 Residence<
PLAN NUMBER
2-6 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
I.
2.
3.
4.
JOB ADDRESS
(eTpqB O eK . ShUB'DaI 115134L
arte
/n a2 21 -LE /% Aid govt
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
D� t7u i ; r�, nC.
ADORE
le Box
CONTRACTOR
ass
CONTRA
a_yn
ADDRESS
PHONE
9a6--o9Ss
PARCEL NUMBER/S
LOTCtura. A. LER /sr ADD
( 5/Se/ - Joos
ZIP
4900(
Required Set Backs in Feet
North5
1 SouthZbD East QT' Iwest29 z
PHONE
Size of Parcel
1.40.4094,323 A /3..3A
ZIP
6.
DESIGNER
PHONE
Type Const. Occupancy
Prot SFR p
asem nt
Valuation
ADDRESS
CHANGE OF USE FROM
TYPE
7. OF
WORK
ZIP
TO
)(ANEW 0 ALT. 0 AD N. D RPL. 0 MVE.
❑ BLD. 0 PLMB. D MECH: 0 M.H. 0 POOL
0 OTHER
Zone Classification
rG eu&t,LtLGet-
IDSp'rinklered
Dues Thio 0 Req'd.
D W L Area
12nn
Building Area in Sq. Ft.
taco
B Area
Split Entry
No. Bath
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
No. Room
7
Storage
Ranche
Rec. Room
Recd. Not Req'd.
DESCRIBE WORK
a. St na e. Fm; ly
_VALUWFION
9. 6-0 Ode)
es, a( hec=
Source GAS
of r.LP
�Utilities!N
a rote? e
EL TRIC
U
WIOP
WATER SEWER
!,u&PP rapt; e .
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 piovisioris of any other state or local law regulating construction or the
performance f construction.
DATE ite %/O0/
(.a RAY.
SIGNATURE rC /OP•G'�+-�p'
DEPT.
SPECIAL APPROVALS
RED':). REC'D.
Env. Health
Planning
Fire Marshall
Co. Engin
UHlitie
SPECIAL CONDITIONS:
Zone Clearance
SEPA Checklist
�loa�
"Anis AP/EpoVED y��7— fD �1�I
DATE 7'2�GV 0FFI CIAt7As// /('�/s�Yarr�/'
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building ' 9`J
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
0
TOTAL 1%%0�
rPte_!.M!T%UMBER
80 -1092-
DATE
389Z
DATE
021* *29500
*.z9soo
*2);5006
E i*00
3891 �0
04-23-80
A 64'79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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$C0. -/e.; I = /0