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1980, 02-03 Permit: 80-1100 AC
rL713ER APPLICATION/ PERMIT Source GAS ELECTRIC SPOKANE COUNTY — BUILDING CODES DEPARTMENT SEWER NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES JOB ADDRESS Z ' LEGAL DESCRIPTION — SEE ATTACHED Single $ LOT BLOCK SUBDIVISION PARCEL NUMBER/S 2. 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 OWNER ONE 3. DATE SIGNATURE— ©� /C,X SPECIAL APPROVALS SPECIAL CONDITIONS: ADDRESS fi 0 �(� C� ZI 3 7 / Required Set Backs in Feet 7C/ SEPA North South East West CONTRACT R PHONE Size of Parcel Zone Classification Other (Specify) 70 4' AD S � ZI Type Const. Occupancy Sprinklered �% / 0 > ❑Yes ❑No ❑ Req'd. DESIGNER 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. TYPE El NEW 1:1 ALT. ❑ AWN.ElRPL. ElMVE. No. Baths No. Floors No. Rooms Rec. Room 7, OF -1 BLD. 1:1PLMB. YLJ MECH: El OTHER M.H.El POOL CERTIFICATE Req'd. Recd. Not Rec WORK of EXEMPTION DESCRIBE WORK FEES COLLECTED 8. ,e a !-'n--- CW -1W -4x-> Gtz.L- VALUATION Source GAS ELECTRIC WATER SEWER of 9. utilities Single $ 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 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 performance of construction. Plumbing DATE SIGNATURE— ©� Mech. SPECIAL APPROVALS SPECIAL CONDITIONS: DEPT. REQ'D. RECD. fi 0 �(� C� Plan Check Env. Health SEPA Planning Mobile Home Fire Marshall Other (Specify) Co. Engineer ,\ PERMIT NUMBER �Q DATE C�V 04* *7,x;0 *7, 00'•> E 1099r�- 0c-15-80 6479, Utilities vv TOTAL $ Zone Clearance (� WHEN MACHINE VALIDATED IN THIS SPACE, SEPA Checklist ` ' ) THIS BECOMES A,PERMIT.