1980, 04-14 Permit: 80-3489 AdditionPLAN NUMBER t • 1.
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 ADDRESS
LOT BLOCK 5 BDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3.
iU Yl i P.it/tir/I_
ADDRESS
PHONE
9924 221
ZI P
99=2/4'
PARCEL NUMBER/54,4,6 —/ 7;-j
Pv rzr c r 8LA- / - ,c . sirs' c r wr 2.o;
rj 4V ,tsXCS• 1I See 047MC6le0
D PP'Rr N I y
Actual Set Backs in Feet
North 'South
East 'West
TRACTOR �
.4--t4C'LC La -44 . .4.(�fiLC.4�
ADDRESS �1
P / .� D ?? 71 l re..�ru.` ".2 ptt/ t
DESIGNER
5' ADDRESS
PHONE
9e2,6'
Size of Parcel Zone Classification
ZI P
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
V uation
/6a0 -
ZIP
CHANGE OF USE FROM
6.
TO
Main Floor
Area o f Decks
,Building Area/in Sq. Ft.
Upper Floors rll Garage Area
1
.zo '
Finished Basement
Storage
Unfin. Basement
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
��l,iDAyESCRIBE WORK �u[I 4�f
8C(/),
ALUATION SO C(.il% ,i,ELECTRIC e WATER SEWER
9., Ago 0.0 UTILITIES
El I
UTILI
Enum. Dist.
ILocation (Area)
Ownership
Public ❑ PrivateX
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 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
DATE OF APPLICATION 4- 7- 1.;..a SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. He
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
TOM ? uJP r -r
SEPA Checklist
11
Building Te hnic(.r
7171746.116-0
4137/gq
4
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
JMech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$28.00
PERMIT NUMBER
gi_ 3 )S'
G2= *2800
*2800
*2800'6
E *000
348.88
04=14-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
04-14- 80
DATE ISSUED
3 4 8, Z
PERMIT NO.
*28.00°
TOTAL
i
TAX SEGREGATION APPLICATION FORM
is (Applicable to the division of one or more parcels of real property into
two or more parcels under different ownerships, also applies to
aggregation of parcels.) _
NAME __A't t•FlttNE E. 'l ^ Y\ \ I.c=2.
ADDRESS I V Co - L 14
PHONE NUMBER (::( -OZa.) DATE I ? O 1c( ✓O
DELINQUENT
TAXES PARCEL NO(S) , 5 5/c) - I'd
ki
I. Enter legal descriptions of all portions to be segregated. Also
include legal description of portions remaining (use supplemental
sheet if needed).
II. Make drawing of entire property. Indicate approximate dimensions
of all property lines. Indicate on which portions of property any
buildings should remain. If a copy of a survey is available, please
attach to this form.
III. This application is to be completed in its entirety before processing.
NOTE: The approval of this application by the County Assessor or his
appointee shall not be construed as authorizing the division of lands for
the l{ jrpseroE4a(FAdA"s' Jdlaklion in violation of RCW 58.17 (Plat and
S1 dty{ ton.A y: gitetiatkrner is hereby advised that no segregation
willtnkitace until this form is completed.
cooly 01
THIS AREA FOR USE BY APPLICANT FOR LEGAL
DESCRIPTIONS AND DRAWINGS. USE REVERSE SIDE IF
NEEDED.
E. 73' cE Lo al 3 3, -7, 4_
g� ;q, G+ id 307'
Jud . E 131 + k) X7.50 t
I
c PA