1980, 11-19 Permit: 80B-3967 RemodelPLAN NUMBER
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APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (609) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
2.
JOB ADDRESS
9 3 't,`+� I[j�
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LOT 6 BLOCiGa SUBDIV SIDON
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LEGAL DESCRIPTION — SEE ATTACHED
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OWNER
[MA SLID e
ADDR SS
- 773 0NA
CON}A O/ GON4 '
5.
I.�6
DESIGNER
1421P4 -E-
3z1
PARCEL NUMBER/5 07I! /I -0
I5o' of kI. Bo' or
03
iso
ZIP
99-2-0 G
Actual Set Backs in Feet
North 'South
East
'West
PHONE
Size of Parcel
150 sc o.
Occupancy
Type Const.
Zone Glassine Ion
//�(�/' �YSpp in klered
❑Yes ❑No D Req'd. -
PHONE
Valuation
Building AreaIn7 Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE'
OF
WORK
❑ NEW 2 ALT.
BLD. 0 PLMB.
❑ AO N. 0 RPL. ❑ MVE.
❑ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not 7�r d.
DESCf2(IBE WORK / 12=>‹1
Enum. Dist. ,
Location (Area)
V LUATION
9. "2O
SOURCE
OF
UTILITIES
GAS
ELECT
WATER
SEWER
v
Ownership —/
Public 0 Private LI
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 riot. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or locow regulating constr .wizen or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPE a 5
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DATE OF APPLICATION
SIGNATURE OF APPLI
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
anning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
g Tec
PERMIT IS NONTRANSFERABLE
cri
FEES COLLECTED
Single
Building
Plumbing -
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
8195. -5,(0
7
02* *1000
*10.00 to -
3.9662
11-19-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
5I9'6.7'z *1.0.0 0 2.pi -
PERMIT NO. TOTAL
0-
0
U
LLI
J
LL