1980, 11-18 Permit: 80B-3924 MHPLAN NUMBER _ "S
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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
1.
2.
3
4.
408 ADDRESS
N •30� MGbokAL•o
LOT BLOCK
SUBPfrv a-rt� coo
OPcc+ s 7-12S
DW10 M - er5�p�ti c
"22 -
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S D 3 /�I 300 .2_01.7
17
►'ma
150c. of tJ, 3o� ��d
OI LC�r„,.6.2,10
cr rl'
vJ. 5
ADDg ESS I560P, ICH
CONER/WGj
PHONE
Actual Set Backs In Feet
North 0 'South
ADDRESS
ZIP
Size of Parcel
Occupancy
Type Const.
East IWest3°
Zonssification
Sprinklered
Oyes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation Builtling re In Sq. Ft.
06.4-0 ; aswl �• I v
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
TYPE
7. OF
WORK
rkl NEW
- 0 BLD.
❑ ALT.
❑ PLMB.
O AD N.
O MECH.
DESCRIBE WORK . �.
8. H c?151 L-
VALUAil'I ON
g IA 00.0
SOURCE
OF
UTILITIES
GAS
❑,/g PL. 0 MVE.
IfG M.H.
0 POOL
ELECTRIC
0 OTHER
ATER
SEWER'//
W
No. Baths
No. Stories
No. Rooms 1No. of wellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership —/
Public ❑ Private (2
Location (Area)
USE CODE
Req'd.
I hered .certify that 1 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 /! —/'f )9°SIGNATURE OF APPLICANTL
SPECIAL APPROVALS
NAME DATE
Env. Health n/ 2
7003
Planning /
Fire Marshall
•Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bull g e Iclan
SPECIAL CONDITIONS:
MAI. To ova N eia,
d�Jo or 4,74 'J is eNt ILL LJl
1,115;
UL O�yp 4w rwski 15617. rvtavt
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'tl"
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home 10 0
Other (Specify) /)
TOTAL $ 19 !
•'" PERMIT NUMBER '
So 43 — 3i%`--
02* *7'400
*7400
*7400
,A *0.00 S
37238
11-14-80
2 6479.
Q7* *10Q0Q
* 100.00 17)
* 100000
A *000
37242
11-14-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED PERMIT NO. TOTAL
Y9Z,111-;i0A00,1.2
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