1980, 12-18 Permit: 80B-4996 ResidencePLAN 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 3 COPIES
JOB ADDRESS
2.
LOT
3
613.1_01rI1 SUBDI I O
IVCI34-
4?F ,a. Coca rv\H%ft 'W+rioN
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3 KOLL CONSYR.(&C-rIOrJ
ADDRESS
C. 1272.( S?ewfyGkic
PHONE
9 fl -4o8,
PARCEL NUMBER/S
ISss t -act 0 -3
ZIP
q tS.
Actual Set Backs in Feet
North �' South Z51
East 30` IWest2.'
4.
CONTRACTOR
SAMe
PHONE
Size of Parcel
Sox %owB
Zone Classification
R.I. S4c3tM2imer0
ADDRESS
Sawn e
ZIP
Type Const.
Occupancy
5.
6.
7.
DESIGNER
PHONE
ADDRESS
CHANGE OF USE FROM
TYPE
OF
WORK
I�/ JNEW
12 BLD.
D ALT.
D PLMB.
TO
O ADN.
D MECH.
D RPL.
❑ M.H.
ZIP
❑ MVE.
O POOL
0 OTHER
V luation
3
• Main Hoar
a32-
Dues
ZZs
• Sprinklered
ONO 0 Req'd.
Building Area in Sq. Ft.
$3Z
tipperGarage Floors Area
s440 Basement
0
Area of Deck
8o L1wiCau44
No. Baths
(
No. Stories
No4o oms
Storage
Unf in. Basement
462-
7.
6a
No. of Dwellings
(
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
B•St NCi.
VALUATION
dr31,SOG
rAH1(C.N/ IZ.S.. i Oen CE
'SOURCE GAS ELECTRIC
UTILITIES
pfielf (JUN Den.
WATER SEWER
Sent c
Enum. Dist.
Location (Area)
Ownership �/ USE CODE
Public 0 Private I!f
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 law regulating construction or the
performance of construction. -SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION J
- en
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
E v. ealth
lann
n
Fire Marshall
Co. Eng i nee
Utilities
Plans Examiner
SEPA
A Chhee
cklist
Build • Technician
SPECIAL CONDITIONS:
APPROACH PERMIT REQUIRED"
Contact County Engineer's Office
PERMIT IS NONTRANSFERABLE
,PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building ?z'0
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 102• °o
,esPCRKIIT NUMBER
X806-% 1
02* ;202.0p
*2020.
*20200,5
A *0.00 0
.48678
12-1E-80
6419.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
b � 1 I
I � f1;}� rtp rsLi' I
DATE'ISSUED Iti8,UI
PERMIT tg.9I,
26 24110AV
•
I -
tS5r- 39s3
I
1191 \
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to-nit:711,o_/1ccl1LLiL
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