1980, 06-23 Permit: 80-6150 AdditionPLAN NUMBER
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
LOT
BLOCK
70 Tip/
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
Cc: P'97?7Ri49(6-
ADDRESS ADDRESS
e. 7/0-)
CONTRACTOR
ADDRESS
PHONE
9106 -/8
PARCEL NUMBER/SLv.T / �,� 34./‹-
et.)
3GKeU,gyp Rif
24534-0 7/,
/0 774
ZIP
c
i9zo
Actual Set Backs in Feet
North 40 4 'South CJ!i' East 3c,` West
PHONE
5.
DESIGNER
ZIP
PHONE
ADDRESS
ZIP
CHANGE OF USE
6.
FROM
TO
Size of Parcel
iO0X t4
Type Const.
V—N
Zone Classification
Occupancy
1e
Valuion
Main Floor I Upper Floors
Area of Decks
Sprinklered
❑Yes ENo ❑ Req'd.
Building Area in Sq. Ft.
eU
Garage Area
Storage
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
VI NEW ❑ ALT.
❑ BLD. ❑ PLMB.
LI AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
V
DESCRIBE WORK
8. Jy,O j/ 7—/ o.N « RF.5/47Cevc'C
44. VALUATION
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
ELECTRIC
WATER
SEWER
ADT/C
Ownership USE CODE
Public ❑ Private el
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 6 —Z 0 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner 23
RM (A/ --r bAbW
SEPA Checklist
Buildi Technician�
gl2Fl w; /P9j
SPECIAL CONDITIONS:
Mrse
+4e-, 5 Pel t (s‘Cb4-,e. 9
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONF YFGR FRC M nATF CIF ISSI IANrF
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ c Ri
r
PERMIT NUMBER
02*
*31,00
*31.00
604.52
06=204-80
2. 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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