1980, 04-11 Permit: 80-3370 AdditionPLAN NUMBER
• wri IN
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
1.
2.
3.
4.
JOB ADDRESS
C. i/6,
LOT
BLOCK
i/Atc (v y
SUB DNVISION
LEGAL DESCRIPTION — SEE ATTACHED
5.
OWNER
C- G. 1090r7,701C,
ADDRESS
C. /WC io i/Ncc Er/ k/*y
CONTRACTO
ADDRESS
s.9?7 d
DESIGNER
PHONE
iiia 6
PARCEL NUMBER/S oppo?rNnvirj/ X /2'
"3„; -,'VS of Al 6 6Xe, C. 11 S ` LYE; /V OA—S 170.
6"XC. S. 94 ' exe N. /o OF s.'o' or e.E7NAzei
/6544 - a4'2q
ZIP
PHONE
Actual Set Backs in Feet
North 'South 75 East /✓ 'West 8'
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Vaation QA
Building Area in Sq. Ft.
/9=9"' 4 8'6"
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
/70`
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
D AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. ADO Srci2/v46'
p.41 VALUATION
9 /JV3c.
Enum. Dist.
` 3 97W t 4,IRiv4e (;PrmeU'r0 ru 4,6
ILocation (Area)
SOU RCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
1 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 constru0o • REVERSE SIDE FOR REQUIRED INSPECTIONS
4 II
DATE OF APPLICATIO ` � �� . 0IATURE OF APPLICAN G'1t
SPECIAL APPROVA S
NAME D
Env. H
/e)
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
"tom Po s-rL )* rr to%Aa
SEPA Checklist
Building Technician
SPECIAL CONDITI • S:
MA►L.. 10 auiNeF---
f -PANS ge-ruP-pi ro
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building '?62•.50
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ '6.50
PERMIT NUMBER •
8o- 3V/0
C2* *2650
*2650
*2650,
E *0.00
333.8=
04-10-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 4r1''1`-8'0 ; 5 7,0 z
*26,,50.°1
DATE ISSUED PERMIT NO. TOTAL
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A
50
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