1980, 06-12 Permit: 80-5671 AC PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESSt* * * !: 0 0
1. S �®,l // LEGAL pESCRIPTION - SEE ATTACHED
i T7 _..
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2.
J. U li
OWNER PHONE t' 03. 1-.� WfA,P7 .53 o37
ADDRESS ZIP nw Required Set Backs in Feet
Q �// J6 1. 0.-
fl/V �9' " North (South East (West 2
4' �C NTRACTOR PH NE Size of Parcel Zone Classification "i 6— 1 —i�li
.�i✓./ A' ,2'4,c//9G'� i Ftp,-G z 'c .i"/��.�'
DRESS / ./ ZI�iJ$9/J Type Const. Occupancy Sprinklered C"t"' / 9.
,4/ /22°. //4.t &2V,t j ,I/ / / he.2..
Oyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OFCIOTHER
WORK ❑ BLD. CI PLMB. MECH. I=1 M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
87/W.
//W0-L—g/e A v/����� —eel /-�-eA/ A„? /// FEES COLLECTED
VALUATION L Source GAS ELECTRIC /%WATER SEWER
of
9. 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 of construction.ruyPlumbing
DATE 10' O �``� SIGNATUR- s446-;""' Z� CMech. 7-:
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health PC
SEPA o
Planning _ w
2
Mobile Home cn
Fire Marshall —
Co. Engineer Other (Specify)
Utilities 1.7Z2TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist (,)�Q�� THIS BECOMES A PERMIT.
DATES OFFICIAL n 0Oi �. '�-� 0— i is f 7° 0 ° t
APPROVED FOR ISSUANCE