1980, 04-01 Permit: 80-2977 AdditionPLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
4111 11SPOKANE COUNTY — BUILDING CODES DEPARTMENT d Z�7
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED
1. �'�
00 T BLOCK SUBDIVISION- PARCEL NUMBER/S
2. 3 1
,LaT3 A34,4--?
OWNER
PHONE
*1A,,i1,1,, 111AI1 ADD /T/D,1/
JN"
g $_� 7�
3
ADDRESS
ZIP
Actual Back Feet
/
D G
`
�o
/
/ Sou h
North
East West % ,
C NTRACTOR
PHONE
Size of Parcel
Zone Classification
4' A OR
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation d�
Building Area in Sq. Ft.
5-761
5.
ADDRESS
ZIP
alp loorUpper
Floors
Garage Ar9a
Storage
�
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
TYPEI$I NEW ❑ ALT. AD'N. ❑ RPL. ❑ MVE.
)�
No. Baths
No. Stories
No. Rooms
No. of Dwellings
7, OF OTHER
-1 BLD. ❑ PLMB. ❑ MECH. ❑ M.H. El POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
DE CRIBE WORK .
Enum. Dist. Location (Area)
FEES COLLECTED
8
VALUATION
SO RCE
GAS I
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
OF
JUTILITIES
Ir
Public ❑ Private
Single $
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
Building
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
Plumbing
DATE OF APPLICATION 37ZY-940 SIGNATURE OF APPLICAN
Mech.
SPECIAL APPROVALSI
SPECIAL CONDITIONS:
NAME DATE
Plan Check
Planning /
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
bs V. )
SEPA Checklist
Building T chnic n
Vl 4444tA ! SEPA
,10.44,tc - 41,67,5--
PERMIT
1, .5 -
PERMIT IS NONTRANSFERABLE
Mobile Home
Other (Specify)
TOTAL $G�gl
*6POC
*68CC
* C, 0 c
2F?6
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
04-0'h—,8"0 297,72
*68.00° -
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