1980, 09-30 Permit: 80B-1119 MHPLAN NUMBER,.
g j3o(Se)
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
Qs ADDRESS
•
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
3. L'el-> (:10
PHONE
9' �V7�
PARCEL NUMBER/S 1•-� 5
0/2 -
ADDRESS( I ' ' C ` A �,
Actual Set Backs in Feet
North-'�7 (South / 1East (West
CONTRACTOR
4.
ADDRESS
PHONE
Size of ParcelZone Classification
5 4111-01`4€'
ZI P
Type Const.
Occupancy Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation JBuilding,iq. Ft.
ADDRESS
ZIP
Main Floor Upper Floors ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks Finished Basemen
Unfin. Basement
TYPE
7. OF
WORK
NEW ❑ ALT. ❑ AD'N. ,❑-,/RPPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. L7 M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK
8. IOigi i.-11 HOM ?C' &4>
VALUATION SOURCE GAS ELECTRIC WATER
9 17 QoO UTILITIES
OF
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not .eq'd.
C JOHT6
J SEW EE R
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 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 construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Ownership USE CODE
Public ❑ Private
DATE OF APPLICATION
SIGNATURE OF APPLICANT Jed
SPECIAL APPROVALS
NAME DATE
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
din9\Techh
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home SO
Other (Specify)
TOTAL $
. 'I
PERMIT NUMBER
SOS— UlcL(
.7* *5000
*50.00 V)
*50.008
A *Goo
9262
0.9-26-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
p9.-3ta=80'111.92 *50,00°--
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
.ir
4
-F -4 + -i-
4-
�` _� jt1
r- yt --i'-
PERMIT NO.
Spokane County
Planning Department
Short Plat
Exemption Certificate
1. WAS THIS PARCEL SEGREGATED BEFORE MARCH.13, 1978, OR WAS APPLICATION
TO SEGREGATE MADE BEFORE MARCH 13, 1978 ?
(exempt under section 3.365 of Short Plat Ordinance)
2. IS THIS PARCEL 10 ACRES IN SIZE OR LARGER ?
(exempt under section 3.3E of Short Plat Ordinance) 1
d
3. WILL THIS PARCEL BE USED FOR A PUBLIC UTILITY FACILITY ?
(exempt under section 3.364 of Short Plat Ordinance)
YES
YES
4. IS THIS SEGREGATION BEING ACCOMPLISHED TO EFFECT A MINOR BOUNDARY
OR PROPERTY LINE ADJUSTMENT, BUT NOT CREATING ANY NEW LOTS OR
CAUSING OTHER LOTS TO FALL BELOW MINIMUM ZONING STANDARDS FOR SIZE
SHAPE OR FRONTAGE, OR AFFECTING ROAD ACCESS TO ANY OTHER LOTS ? YES
(exempt under section 3.3H of Short Plat Ordinance)
5. IS THIS PARCEL ZONED RESIDENTIAL OFFICE, LOCAL BUSINESS, COMMERCIAL,
FREEWAY COMMERCIAL, INDUSTRIAL OR MANUFACTURING ?
(exempt under section 3.364 of Short Plat Ordinance)
APPROVED BY:
I hereby certif
this exemption are true
nswers—i—hake offe
YES
NO
DATE: i /wet)
in connection with obtaining
APPLICANT'S SIGNATURE:
E: /
N /21 n.1ktASON SIAL T
SPOKANk WAblIINtIUN 9944)0
PNUNt 456.2d05