1980, 01-11 Permit: 80-75 AC PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT `" S 0 —15
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATES 4r
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES f
JOB AD SS1. . .k...7• C/ ./d/ — . t.4:-4. f ). 'LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2.
OWNER i PHONE L
3 . — ; .4, ,.z.e,.,,..,) aP 7
A unoo RESS ZIP Required Set Backs in Feet
9 X4.1 �i
��� +� ' l 9,20 North South East 'West j --- , •-
C TRACTOR ' /�I PHONE Size of Parcel Zone Classification
0 t . :J -�.-L--`_ (1 PHONE
• -,;(?f •_/,...5-=--;?/ t'.I`. ',
4' AD ESS//�� Z12 Type Const. Occupancy Sprinklered
•
/lj_/ ,/ X-�.L.L�G-t2._.t2F C/9---'20,-;%7 ❑Yes ❑No ❑ Req'd.
DESIGNER '7` PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area 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 R<
EW EW ❑ ALT. ❑ A5.'„.N. 0 RPL. 0 MVE.
7, OF 0 OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK 0 BLD. 0 PLMB. MECH: ❑ M.H. El POOL
of EXEMPTION
DESCRIBE WORK 1 /��� 4 .4 FEES COLLECTED
VALUATION ! Source GAS ELECTR WATER SEWER
i 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
Plumbing
performance of construction.
L'
DATE/" J 0"62 SIGNATOR A.-` - - Mech. 7 C/G
SPECIAL APPROVALS SPECIAL CONDITION-.
DEPT. REQ'D. REC'D. Plan Check
Env. Health rx
SEPA
C.)Planning
w
Mobile Home z
Fire Marshall —
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
• WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist L 1 11 r Q} �� THIS BECOMESIA PERMIT. ,J_ ` ,,
DATE 1�" —SOaitn - i - 11 -
APPROVED FOR ISSUANCE _