1980, 11-12 Permit: 80B-3582 AdditionPLA" NUMBEk APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
k.,/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS I
1. I LEGAL DESCRIPTION — SEE ATTACHED
LOTBLOCK ISUBDIII,� JV� " PARCEL NUMBER/S �'7 1� 1 (�21 �
3. �Mir,6, A���,- u
ADDBE � 1<0
I� 1X
CONTRACTOR
4' AD E S
DESIGNE
IP Actual Set Backs in
North Sou
HONE Size of Parcel
Type Const. O
HONE Valu t'
East 1 () West
Zo a Classificati n
-
cy Spri klered
❑Yes ❑No ❑ Req'd.
Building Area, in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
TYPE ❑ NEW ❑ ALT. LTJ AD'N. ❑ RPL. ❑ MVE.
7 OF ❑OTHER
CERTIFICATE
Req'd.
Recd.
Not Rsq'd.
WORK I/BLD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
of EXEMPTION
DESCRIBE WORK
le
Enum. Dist.
Location (Area) FEES COLLECTED
8.
b e
a
VAL ATION SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
OF Public ❑ Private
9. UTILITIES
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
r
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 INSPECTIO
Plumbing
DATE OF APPLICATION T ! SIGNATURE OF APPLICANT r
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
(f -?a, ,, 3 ! 1U Isa .xtL-yLui �l'l
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
P��RjMyI�T NUMBER
�J� lIJ5
2-
25 6 C
*5600`
ri n
-5 5 1, 7 -
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
T ctn r� PERMIT IS NONTRANSFERABLE1'l 3 5 0.2 z *560000P1
�3i.0 CK �v