1980, 03-04 Permit: 80-1780 Pole BldgPLAN NUMBER
JOB ADDRESS
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L T B
2 O'' ,,,,
W, N1 ER
3. 1
ADDRESS
NT �?C
4'"ID-DRESS
DESIGN I
5. ADDRESS
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
" LEGAL DESCRIPTION - SEE ATTACHED
SrA
SUBDIVISION T, PARCEL NUMBER/S /1
IJ IIZEiA 1,1d�IITIKIL (iiEu.? j%,iDr3; Li /4,0 -AC .4�.
P ONE
1 ZIP Re d Set Backs r in Feet
t r 1 < N r outh 3 East West
OR PHONE Siz of rcel Zone Cla9ffniCalgn �f
ZIP T pe Const. Occupancy Sprinklered
PHONE
ZIP
CHANGE OF USE FROM TO
6.
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 WORK BLD. ❑ PLMB. ❑ MECH: ❑ M.H. El POOL OTHER
OF ❑
ES RIBE WORK j
s
8 ` _ _ _ ' �� art �/ FEES COLLECTED
VAL ATIO Source GAS ELECTRIC WATER SEWER
of
9. 0 Utilities
Single $
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 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.
Plumbing
DATE ` 3 — SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CCONDIT�INIfON�/I I p
DEPT. REQ'D. RED. O I LV�J Plan Check
j Env. Health
SEPA
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
60d `Cd Mobile Home
Other (Specify)
DATE OFFICIAL
TOTAL $
PERMIT NUMBER
�:]
r�o
DATE_
1 7
G )`l'v
r 679
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�cf4n� 'nr
❑Yes
❑No ❑ Req'd.
luation
Building ry,rea.in.aoq.
Ft.
DWL Area
Basement Area
Gara e
Arrea1
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No, Rooms
Rec. Room
CERTIFICATE
Req'd.
I Recd.
Notpeq'
of EXEMPTION
8 ` _ _ _ ' �� art �/ FEES COLLECTED
VAL ATIO Source GAS ELECTRIC WATER SEWER
of
9. 0 Utilities
Single $
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 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.
Plumbing
DATE ` 3 — SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CCONDIT�INIfON�/I I p
DEPT. REQ'D. RED. O I LV�J Plan Check
j Env. Health
SEPA
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
60d `Cd Mobile Home
Other (Specify)
DATE OFFICIAL
TOTAL $
PERMIT NUMBER
�:]
r�o
DATE_
1 7
G )`l'v
r 679
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�cf4n� 'nr
w - . -
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