1980, 04-02 Permit: 80-2998 MH IPLAN NUMBER a APPLICATION/PERMIT PEG✓1..�' NUMBER
1 SPOKANE COUNTY — BUILDING CODES DEPARTMENT �'1 �-
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
Y
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES 7 * * 5 0 0 0
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED * 5 r, `, C:.
.55
1. e. /7s/c/ 6 -"//11/6-
LOT
Nj/1/tLOT />
BLOCK SUBDIVISION PARCEL NUMBER/S C Q 9 7
7
2. /6 ,1PPLd Ut1aE si 6-757/07-es- 2"1' 400/ 7"/
02-3 0
OWNER PHONE 0 1 — i7
/9s'S z-/9/
3. ERivL�Sr C�qG/STk'c 9z6 - 99z 6 G 7 9.
ADDRESS ZIP Actual ccccSett Backs in Feet
�' 7,3
•/ /S/ 6 TI"1 jf1/G. 99 0/4 North 7 (South 4/C- East 'West 3c}
CONTRACTOR PHONE Size of arcel Zone Classification
X47£ X/-7,, - /170,72,- . tikAli
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5.
ADDRESS ZIP Main Floor Upper Floors Garage Area Storage _
7Z.0
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
No. Baths No. Stories No. Rooms No. of Dwellings
f
TYPE NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE. / / 7d
7, OF ❑ OTHER
WORK 0 BLD. 0 PLMB. 0 MECH. xM.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WOr"rEnum.Dist. I Location (Area) t
8. �/�s:N,e4 "cite-"cite- Mr 4s ResioE�v (COC ���ct FEES COLLECTED
1
VALUATION
SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
OF
9. Ul`i.LITIES Public ❑Private Il]
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.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS / Plumbing
DATE OF APPLICATION -- -#__/_...-_ .
SIGNATURE OF APPLICANT d /� (.l��� Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Env./ 4 `KW LyG�1/te SEPA >n
Planning
O
Mobile Home •56'°° ''�
Fire Marshall --J
CC
neerOther (Specify)
'` �I ;i/
17° fra
.i.. ,i—)t-
TOTAL $ 6-0-°n
r pq: #� g p� p�
Plans Examiner �ea� f't p`gy.q� y�'gi.?I�9l�'@�1�
f1�c° ice WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
C. •.. . THIS BECOMES A PERMIT.
1\ing T iclan PERMIT IS NONTRANSFERABLE n '4 0 2:-8 0 2 9 9. 8 z * 5 0. 0 0 2
`~�� PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
,
,\•\,
/
2/
Z9 I