1980, 02-14 Permit: 80-1176 ACPLAN NUMBER 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
JOB DDRESS
/ , __9/ y ),I" LEGAL DESCRIPTION - SEE ATTACHED
L T BLOCK SUBDIVISION PARCEL NUMBER/S
2.
OWNER // PHONE
3.
A R S �/ / ZIP / Required Set Backs in Feet
�' �! f �- Y L j t �' t -�. e� / � _� J North South East West
CONTRACT R PHONE Size of Parcel Zone Classification
4' ADDRESS y_..J / ZIP Type Const.F Occupancy Sprinklered
J1 c -;:2 ❑Yes ❑No ❑ Req'd.
DESIGN R PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE NEW ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER Req'd. Recd. Not Req'd.
WORK ❑ BLD! ❑ PLMB. IxMECH: ❑ M. H. ❑ POOL CERTIFICATE
of EXEMPTION
DESCRIBE WORK< FEES COLLECTED
8. )Z-*� LC�.1'.-{ e 'Ikl Y-
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities 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 Building
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
Plumbing
performance of construction.
DATE SIGNATURE_ Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Other (Specify)
Fire Marshall
Co. Engineer
Utilities
TOTAL $
Zone Clearance
//��
I7AT112-1 7{� {� (-)FFI('IAI
WHEN MACHINE VALIDA7
THIS_BFCOMES A �ERMIT.
SEPA Checklist
PERMIT NUMBER
M
DATE
A 7.01!
1 1 7,5
CC -14— 0
,� 6.4 7 y.
IN THIS SPACE,
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