1980, 07-28 Permit: 80-7771 DemolitionPLAN 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 3 COPIES
JOB ADDIRESS (' A
1. k • � VW�VVI
LOT
2. 4—
BLOCK
1+2—
:LF.GAIL DESCRIPTION - SEE ATTACHED
SUBDIVISION
OWNER L��_
3 til
PHONE
PARCEL NUMBER/S 175 4-3 - 12 D /
ADI
RE6 44-o i " `– L, I/V
ZIP
4.
5
6.
CONTRACTOR
I � nq.ote4-r0NI
PHO
Actual Set Backs in Feet
North 'South
Size of Parcel
East (West
Zone Classification
trcc/t,n-r-6K
DESIGNER
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
AD ESO2 -
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
CHANGE OF USE FROM
ZIP
Main Floor I Upper Floors
Garage Area
Storage
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑,/NEW LI ALT. ❑ AD'N.
lE BLD. ❑ PLMB. 0 MECH.
O RPL.
O M.H.
DESCRIBE WORK
8. K i 2 176m014-1(
GAS
VALUATION
9.
SOURCE
OF
UTILITIES
O MVE.
❑ POOL
OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Location (Area)
Req'd.
ELECTRIC
WATER
SEWER
Ownership,.{/
Public ❑ Private KJ
USE CODE
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
type of work will be complied with whether specified herein or not. The granting of '-rmit does n resume
to give authority to violate or cancel the provisions of any other state or local law( ing co/j cti or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
%.�, L
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
7/2-S
SPECIAL CONDITIONS:
,kb/(YtA
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
NotR,q'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
Iv,
$
02* *1000
* 10.00
* 10006
E *0.00 0
777.08
07-28-80
2 6479
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
07,-12.8-80
DATE ISSUED
ED IN THIS SPACE,
777..12 *10.00d1 -
PERMIT NO. TOTAL