1980, 11-25 Permit: 80B-4216 AdditionPLAN NUMBER
fir 20121713
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 -COPIES
JOB ADDRESS
1. e. 64. 3
LOT
�,a.tru� Ci rL�
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
2.
7
OWNER
3. aa
Pit,6. bit&
DR `D
Daess
7C n_ %ata Leat CLri — .� hructe
CONTRA TOR
-MI AAA/ Itt ekrudi
SUBDI ISI NieLAAA,p
5.
RESS
. (3; 7?.t kc— / p,f.cii t
DESIGNER
PHONE
9.2-4499/z)
PHONE
.g4 —44/
ZIP
D/9206
PARCEL NUMBER'S
CUr 7 acK
PFALMJ K/ ADO
Actual Set Backs in Feet
North /J/t/ 'South
East 4L (west/ -2
Size of Pgrcel / I Zon€ Classification
7g k/4,7: 111
Type Const.
Occupancy
,(4.71.l./at.Y,ta1. Jt9/d—
SprInklered
e. Oyes DNo D Req'd.
PHONE
Valuation , f M/H/.V FLOCK
37,0 ROD/TION.
Building Area in q. Ft.
2 0/S
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
Li/ NEW
D BLD.
D ALT.
❑ PLMB.
AD N.
0 MECH.
O RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
/
No. of Dwellings
1.
CERTIFICATE
of EXEMPTION
Redid.
Rec'd.
Not Redid.
X
8.
9.
DESCRIBE WORK
V LUATION
SOURCE
O
UTILITIES
GAS
a�(�JAA^CJI
Ytazeogeoci
ELECTRIRIC WA ERR
Enum. Dist. I Location (Area)
SEWER
Ownership
Public 0 Private clit
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 lawsegulating construcipn or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIOI
DATE OF APPLICATION /1"/..3--6>O SIGNATURE OF APPLICANT,
E
SPECIAL APPROVALS
i
NAME DATE
nv / '/ i //
ann
ng
Fire Marshall
Co. Enginee
Uti lit,es
Plans Examiner
Td 'os
SEPA Checklist
Il7
50
Bu ding Tecbmcia
4 L a
SPECIAL CONDITIONS:
k/CENSE -dg— sr?)
or /WO -
o(' j ,2+c, .y'LL !/tf"-'GP/c:..a/ O *
JtAtozx tC, & ,1,C4 -4°÷9c414 -if
nn •
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
✓ D
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home •
Other (Specify)
TOTAL
$ 44_
"HERMIT NUMBER
02* *4400
*44.00 '6
*44,006
A *000
36882
11=13-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
42161' 4,4410.0:!i12. -
PERMIT NO. TOTAL
›-
0-
...J 0
V
W
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