1980, 03-12 Permit: 80-2141 Residence ,
PLAN NUMBER_
APPLICATION/PERMIT PERMIT NUMBER i 2 Yd-.1-i*/� ' SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE 5`/`Z—g‘)
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
02 * * ''£ 3.00
JOB ADDRESS p��,�, �_ LEGAL DESCRIPTION - SEE ATTACHED * 2 F'. 3. 0 , u
LOT BLOCK S�BDrIVI510 PARCEL NUMBER/S pQ/QT-c3.7�0 SLJ-Q�j0(, * 2 3.0 0 c_
2. ot .Z Jf—CA.41 C� - L-o r�. . A3�IC 1, E 0 0 C
/i�/
OWNER ``�, PHONE
3. , ut 7t4A e- Q�6)-OgT 11.EA/pi 1C K,5 W ADD 2 1 4,0
ADDRESS ZIP Required Set Backs in Feet ` ` /
P t 7 -a.,O 1 d.,I,e j, AJI.: �4a4 a,uj �'gf.zzl e, North i / (South/'0 IE st 80 (West 30 C 3- 1 2-8 0
CONTRACTOR �T T'�7 A/ msµ'-`- PHONE Size of rcelj one Classification� tia/1r1�.� _ 2 Q x i....16, i.--tI S'� ega./-te— �7 6 4 ! 9.
AD4' �/yRE" SS ZIP Type Const. Occupancy pppr inklered
8d /- Lives No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq.eFt.
5. 4 a// �D °`� / 7 7
ADDRESS I ZIP DWL Area / 'Basement Are, Garage Area Storage II
i.2.1Z / ADZ hie
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. k
No.Baths No. Floors No. Rooms Rec. Room
TYPE rutNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. /Q
Al
7. OF � CI OTHER CERTIFICATE Req'd. Rec'd. Not Req'd.
WORK BLD. ❑ PLMB. ❑ MECH: ❑ M.H. CI POOL
of EXEMPTION
D SCRIBE WORK ' FEES COLLECTED
8.
.V LAA 10� So rce tirGAS ELECTRIC WATER SEWER
jC/ of
9:9'� Odd Utilities Single $
—
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
f q6
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building 7' .
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 re. . 'ng construction or the
Plumbing
performance of construction.
DATE "I/-g'4 SI fCIATURE_ 4 _ Mech.
SPE IAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health ILdiE� ,,.,/ ,5.—
�4 cc
SEPA ccb
Planning
— w
Mobile Home Cr)z
Fire Marshall
Co. Engineer Al / �" �L � / sett., Other (Specify)
A /
Utilities
ai-Ake �ty1.2E� TOTAL $ .2 Y3
Zone Clearance a/G-e
WHEN MACHINE VALIDATED IN THIS SPACE,
'' r�ti� t�VP-'.UCP THIS B€COMES A PERMIT. ,.. z (' O
SEPA Checklist . ik-
H/,�Oryp 1E e'S/ LA TY °�'�°" DATE3`)u"YDOFFICIAL. / 4,-- / 1 r. 1 L '.. i; 1 lJ. J �I J t- i-
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L.- K APPROVED FOR ISSUANCE -
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