1980, 12-05 Permit: 80B-4519 ResidencePLAN4
,v16ER
r0,
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
5 34107
LOT
BLOCK
'NIOC) rat.
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
o
N 6 vs/47")Y
PHONE
CiZs-5 yr
p -n4 0 tt zz.R54" -ci089
ADDRESS
►4 BTN
CONTRACTOR
ZIP
94Z06
Actual Set Backs in Feet �w�,I'
North IQ (South z.;' LEast 44 (West .31,1
AN 7�r=1A M 'C'E R2+S
ADDRESS
' )c 4- CIO
DESIGNER
Ccnry T.
PHONE
ct Z-Co-9'IS
Size of Parcel
11 D X 1 vc
Zone Classification
Nca c. FAY11 I L Y
ZIP
q4_ 9
Type Const.
Occupancy
R -3
PHONE
luation
EICO
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
73Z 8(04
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
.4> 40
TYPE
7. OF
WORK
Yr NEW ❑ ALT.
L10 BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
Noiooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not j eq'd.
DESCRIBE WORK Enum. Dist. I Location (Area)
8• �+NG1. FA iii,/ - +t1clV 6 J2ArC17 AirrAC4+a"J 1
Tl Ownership
1UTILOITIE9� ��"j iG Public ❑Private LY/ USE CODE
g��} VALUA ON SOURCE GAS ELECTRIC WATER SEWER
� G.i.g08
I hereby certify that 1 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 al law regulatig.construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INS 10
DATE OF APPLICATION 1 t -S0 SIGNATURE OF APPLICA
SPECIAL APPROVALS
NAME DATE
Env e .
Pial'fning
Fire Marshall
lajb
Plans Examiner
SEPA Checklist
Buildi Technician
SPECIAL CONDITIONS:
l.1 6A1 6k
ItJ2t j 8 (
rviA
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
4" 337.x.
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 3'31 . od
r
a.MIT NUMBER'
02* *3`7,00
*337.00 rri
*377.006
A *0,00
430,62
12-0 -80
z 61079.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12;-05-80
DATE ISSUED
45192 *537.000 -
PERMIT NO. TOTAL