1980, 12-29 Permit: 80B-5238 FurnaceNUMBER
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
C-, f„3 Mk<-� LEGAL DESCRIPTION —SEE ATTACHED
OCILOT I BLOCK ISUBDIVISION PARCEL NUMBER/S
2.
OWNER PHONE
3. V, t WN
ADDRESS
ZIP
Actual Set Backs in Feet
t
.t7.�7G �4-�CA'Z_
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4. ADDRESS
ZIP
ZIP
Type Const.
Occupancy
Sprinklered
. G3C�1 'Tf2eAjT
Dyes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
TYPE �/
t1� NEW ❑ ALT. ❑ AD -N. ❑ RPL. ❑ MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwelling
7, OF�/ ❑ OTHER
1-1 BLD. 1:1�cl PLMB. MECH. ElM.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd
WORK
of EXEMPTION
I
DESCRIBE WORK
Enum. Dist.
Location (Area)
8. St-aGTf-4 C t o -c- "Ac-cr 4- i 7uG 1C
FEES COLLECTED
VALUATION
SOURCE
GAS
ELECTRIC
WATEROwnership
SEWER
USE CODE
9.
OF
UTILITIES
Public El Private ❑
Single $
1 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
Building
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
Plumbing
j A pts.'n1 F �ec►.c.^k'f-e.+�
nATF OP APPI ICATInNI Qlr]NATI IRG r1C ADDI WAniT
. � �
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Env. Health
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer Other (Specify)
Utilities
Plans Examiner
SEPA Checklist
Building Technician PERMIT IS NONTRANSFERABLE
N4E-IMIT NUMBER Q
., L. j. /
6a 79
TOTAL $ % • Geri
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.