1980, 08-05 Permit: 80-8160 ResidencePLAN NUMBER
{�. - d 6 9 V eV Fro
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
LO BL CK S B Y ON
2.S /
OWNER
3.
AD RESS
i a . r / P ie. -Fa -tux ,...42.4444e€
CO TRACTOR
• ADDRESS J
LEGAL DESCRIPTION - SEE ATTACHED
PHONE
9.z. 44g7
PARCELNUMBER/S SSV c/- LL los
c. orS 13L1( /
1-4 L.,_,C frrs A 00
ZIP
99zi 6, •
Actual Set Backs in Feet
/
North AS' ISnnth4/.0 East `/DApPIWest
PHONE
ZIP
SizeLof Parcel
--rra 4,(%71
Type Const.
Zo a Classifiicationn
Anied
Occupancy • prinklered
Oyes ❑No 0 Req'd.
5.
DESIGNER
PHONE
ADDRESS
ZIP
V lua t ion
,3171;
Main door
goo
Building Area in Sq. Ft.
pdo7
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO •
Area of Decks
g0
Finished Basement
Unfln. Basement
gee
TYPE
7. OF
WORKt,
DESCRIBE WORK
8. Litt 4e .r J./
9.
k, NEW
0 BLD.
❑ ALT.
❑ PLMB.
❑ ADN. 0 RPL. OMVE.
O MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
1
No. Stories.
No. Rooms
•hp
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
AL'}ATION SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Enum. Dist.
Location (Area)
Ownership
Public 0 Private j%1
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 law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS f
DATE OF APPLICATION 7 —36— g -U
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
n NAME DATE
Env al
PI nning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
/\But Ing T chn Ian
/ rJ(a /ti .ZQl
SPECIAL CONDITIONS:
MAL -W a/414
"APPROACH PERMIT i2E�1iIRED„
Contact County Engineer's Office
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building AS- �O
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
oa
TOTAL $ .I /s�
l ▪ PERMIT NUMBER
PERMIT
02'* *21500
* 2.1500 .175
* 215006
E *0.00
79432
07-3.1:-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0''8:'-+.0; Sil`.i 81'0;
DATE ISSUED
8 16 02 sf2'1500
EL �
PERMIT NO. TOTAL
-41 U142:4t
0 i
Ni9k.A1._w
IL
2
61/ _ 80