1980, 10-14 Permit: 80B-1967 AdditionPLAN NUMBER
if5e
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
E, lIz3
LOT
BLOCK
'1' AVS
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIVISIO
OWNER
C. . A. 5-T v B U R G -Z
ADDRESS
I 172, 3 TF1 AVE -
CONTRACTOR
5/111
ADDRESS
PHONE
PARCEL NUMBER/S E 2 of Lo -r 8 5L.OG/C., 179
oP�ol�-runr I-ry
2i5L/-/- /oil
ZIP
Actual Set Backs in Feet
North 12.8 'South 2..5 1East 30'West 23
PHONE
Size of Parcel Zone Classification
loo ' X zoo' A 2)GUL-ruRAL.- NLS
ZIP
Type Const.
V N
Occupancy
12.-3
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
00
12..,*. 'O -rXX
Building Area in Sq. Ft.
SZp
ZIP
Main Floor
520
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW ❑ ALT. ff-AD'N. ❑ RPL. ❑ MVE.
g BLD. ❑ PLMB. ❑ MECH. 0 M.H. 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. ADP117ON 6 - -U10 6645RonMS -To£ ---
VALUATION
9.1/2j 4yo
co
I hereby certify that I have read and examined this application and have
SOURCE
OF
UTILITIES
GAS
ELECTRIC
� S
WATS
WATER
Enum. Dist.
`Location (Area)
II
SEWER
Ownership
Public ❑ Private E
USE CODE
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 INSPECTIO S
DATE OF APPLICATION w t � �%6#77 SIGNATURE OF APPLICANT.z Air,/
SPECIAL APPROVALS
NAME DATE
nv al n
P nning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
Tool Po-siLFl �-r( 193/ y
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
G% i�
TOTAL $ (5 ky-
PERMIT NUMBER'
br Z
u�* *9E00
*9E00 N
*9E006
A *C- 0 0 ES
19662
10-14L80
2 6.479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
L i 14'!'' 8P0 19 6,
*98,00°I -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL