1980, 01-29 Permit: 80-686 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES c d * s i. 1) 0
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED x 7, {` ``
1. 4----, /'9/. 6- \5094/e,} /�N%lllc=�es * 7 0 G
LOT BLOCK SUBDIVIS ON PARCEL NUMBER/S
2. E Q. U C: 1)
PHONE
3. D/!' R il / Div
v/ S
9a8.4079=3Z 6 <' 5
ADDRESS ZIP Required Set Backs in Feet q
6/9/O5 Spm,99e9 , / 9e /6 North (South East (West
CONTRACTOR PHONE Size of Parcel Zone Classification c 6 1 7 9.
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ENo ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No.Baths No. Floors No. Rooms Rec. Room
TYPE Ai NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF 0 OTHER
WORK ❑ BLD. ❑ PLMB. X MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK FEES COLLECTED
8. .�/1s `AJ/I�ie/J lt �cthy OUB�c/ nto-ee,
VALUATION Source GAS ELECTRIC WATER SEWER
9. 4/v1.2..2.- 0 4,, of
. ilf
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 . not. le granting of a permit .oes not presume
to give authority to violate or cancel the provisions of any oth-r state or local law regulating I. truction or the
performance of construction. �I� Plumbing
DATE /�9//p SIGNATURE I ai(/L�7 a , '� Mech. 76'
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health ,'r
SEPA
Planning
i
Mobile Home ..'
Fire Marshall --
Co. Engineer Other (Specify)
Utilities TOTAL $ _ 7�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist it."_ 111111111 a , THIS CO ( AgEIRMIT.Ul d 8,6d * 7. 0 O H
DATE OFFIC1s _
"',VED FOR ISSUANCE