1980, 07-24 Permit: 80-7587 MHPLAN NUMBER
?/1,4ifo
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.
JOB ADDRESS //�.�/ I��
S. i` 2•3
LOT BUCK SUBDIVISION, '
ry I� Avortin.,
LEGAL DESCRIPTION -
OW;1I%c LI r\1 ..J"I rIV`N1�1
ADDRESS o I G(C11�J I�1ON I) W 4/
CONTRACTOR P'I �)
PHONE
PARCEL NUMBER/S Z3
Lo-rG I.LocK 5 -XG.
Actual Set Backs in Feet
North r7 South QS
4-1
PERMIT NUMBER
g -15-g 7
SEE ATTACHED '0174
- I 137-4,<4/V133
East
❑Yes
(
(West
Size Zo(te C
arcel lassificatin
6 x97 & RIC- -
ADDRESS
ZIP
Type Const:•
Occupancy
5.
DESIGNER
PHONE
At
Valuion
-P.
ADDRESS
ZIP
Main Floor
Sprin Iered
❑No 0 Req'd.
Building Area In Sq. Ft.
2q -y48
Garage Upper Floors Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
VNEW 0 ALT. 0 AD N.
0 BLD. 0 PLMB. 0 MECH.
❑RPL.
VM. M. H.
❑ MVE.,
0 OTHER
❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
DESCRIBE WORK
q� Mos Lr - 0115.
9167. oozi
SOURCE
OF
UTILITIES
241)(1.48
Enum. Dist.
Location (Area)
G
ELECTRIC
WATER
SEWER
c Io
Ownership J/
Public 0 Private 0
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
td give authority to violate or cancel the provisions of any other state or local law regulating constructio Q the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Hoa h
PI
nni g •
r all
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS: 1'
krnc F1404,10 iN e fr}°!at cf wi v110114 to Pn
DtJ3, kJIor ONX AtAAAino 1814810
/fAAR. 73 ocJ,refl
N10 coHO('t"IoNS PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
4\00, on
Mobile Home
Other (Specify)
TOTAL $ tie.C'i
* 1 op 00
* 10000
* 100006
E *000 8
6972
07-.1.11,180
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0,7,4,2141,781'0' 758.7=, *1'0'0,00,,°r2
DATE ISSUED
PERMIT NO.
TOTAL
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