1980, 12-10 Permit: 4741 DuplexPLAN NUMBER
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
1. E. 10`►14-I (c NoR_A
LEGAL DESCRIPTION - SEE ATTACHED
LOT
•
2. 1
BLOCK
SUBDIVISION
011S5tos'3 QC -a 71ADID171oyj 1.57
OWNER
3. G Aa'/ —P-071'3/4
ADDRESS
e. tot24 FEa-sae-r D2.
PHONE
4a8- -?48
PARCEL NUMBER/S
Oct 543-t$ol
ZIP
giCtzcC
Actual Set Backs In Feet
North .213 "South
East 1Z I West lbr
4.
CONTRACTOR
Sans
PHONE
Size of Parcel
•a
ADDRESS
C. AMC
ZIP
Type Coo; t!j Occupancy
Zone Classification
('1GLrt FAp14tc.V
Sprinklered
❑Yes 0No 0 Req'd.
5.
DESIGNER
PHONE
ADDRESS
ZIP
Valuatloqt
t —1 ,oco&
Main Floor
820
Buliding Area in Sq. Ft.
I(o8o
Upper Floors Garage Area
T
Storage
CHANGE OF USE FROM
6.
TO
Area of Do ks
'240(4"
Finished Basement
1104
Dnfin. Basement
TYPE
7. OF
WORK
NI'NEW 0 ALT.
gBLD. 0 PLMB.
0 AD N. 0 RPL. 0 MVE.
0 MECH. 0 M.H. 0 POOL
0 OTHER
NO. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE •
of EXEMPTION
Req'd.
Recd.
Not Req' d.
DESCRIBE WORK
8. T La l?c.ax 6 P.a.,
VALUATION
I.eos
SOURCE
OF
UTILITIES
GA
ELECTRIC I WATER
Enum. Dist.
Location (Area)
SEWER
SE..FT' C
Ownership �/
Public 0 Private n1
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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. EE REVERSE SIDE FOR REQUIRED INSPECT! _S ,
DATE OF APPLICATION
Z
SPECIAL APPROVALS
NAME DATE
Env. Health
k46i�
/a,/,o
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B tlm echnician IC
41
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
P4MN e'N5< o /2/'7)79 By T crcccwa1r
"APPROACH PERMIT REQUIRED"
Contact County Engineer's Office
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ -no
PERMIT NUMBER
Off'- 4741
02* *349,00
*34900 N
*349.00'6
A *0.00 8
473.2
12=1080
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
41411 *3!49.00
DATE ISSUED PERMIT NO. TOTAL
0-
C.)
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q 0 0 8 0: Z 9 1:3
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0
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1000 0 ii„ p4,C
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