1980, 06-17 Permit: 80-5906 ACPLAN 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 4 COPIES
JOB ADDRESS
1. !� /I/
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Source
LEGAL DESCRIPTION -SEE ATTACHED
LOT
BLOCK
SEWER
/J
PARCEL NUMBER/S
2.
I
ISUBDIV191ON
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aS i 7
OWN R C
PHONE
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3.
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03
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ZIP �/
Required Set Backs in Feet
North South East West
DESCRIBE WORK
8.
CONTRACTOR
VALUATION
Source
PH+�
Size of Parcel
Zone Classification
SEWER
/J
9.
of
Utilities
cE,
4'
ADDRESS
ZIP
Type Const.Occupancy
Sprinklered
I hereby certify that I have read and examined this application and have read the "NOTICE” provisions included
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on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
Building
,�/
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
E] Yes❑No ❑ Req'd.
performance ofconstruction.
DESIGNER
DATE � SIGNATOR
PHONE
Valuation
Building Area in Sq. Ft.
5.
DEPT. REQ'D. RECD.
Plan Check
Env. Health
ADDRESS
SEPA
ZIP
DWL Area
Basement Area
Garage Area
Storage
Mobile Home
CHANGE OF USE FROM
TO
Other (Specify)
Split Entry
Split Level
Rancher
6.
TYPE El NEW
1:1 ALT. ❑ AD'N.
❑ RPL. ❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
❑ OTHER
CERTIFICATE
Req'd.
Recd.
Not Rei
❑ BLD. ❑ PLMB. MECH: ❑ M.H. ❑ POOL
WORK
of EXEMPTION
I
DESCRIBE WORK
8.
FEES COLLECTED
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
of
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 ofconstruction.
Plumbing
DATE � SIGNATOR
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
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TOTA L $ 1'1, yd
PERMIT NUMBER
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DATE %-840
:9 `5: I 7
U. 'J �• — 1 1
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WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B5COME,S,A PERMIT.
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