1980, 10-15 Permit: 80B-2078 Barn, Renewal of 79-4220 PLAN NUMBER _ � 74e7APPLICATION/PERMIT PE UMBER /
SIOKANE COUNTY — BUILDING CODES DEPARTMENT
V NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
r
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS ( * * 2 5 ? 0
1. 5', �c� l 17- LEGAL DESCRIPTION — SEE ATTACHED , G
LOT BLOCK SUBDIVISION PARCEL NUMBER/S r ~
2. 1" 1st0I-r10tJ is L 17- Z2 4 AI s-� 7_.cpf or- * 2 5 5 0
OWNER ` * PHONE ' `yam
11rIA� �PS I ✓'1.2A I V ' * 0 n
0 ( B3 ADDRESS ( ( c Z P Actual Set Backs in Feet
irwV� I �a i f-i' 8p 4� I I 2 (: 7, «,
( 7 North South East West
CONT 051 _` 'V, PHONE Size of Parcel Z ne Classificat' n 1 lJ- I 5-8 0
l'el.-3 ›cr,G
4' ADDRESS ZIP Type Const. Occupancy Spr' klered �'. 7 9.
Oyes ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft. ` `I r
5' ADDRESS ZIP Main Floor Upper Floors Garage Area Storage 1 0- 1 -- 8 C, -
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement ,Li 7 9
6.
No.Baths No. Stories No. Rooms No. of Dwellings
TYPE 0 NEW 0 ALT. ❑ AD'N. 0 RPL. 0 MVE. u
7. OF ❑ OTHER
WORK
Iit/BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
8.
DESCRIBER� 1 I �� :4-4721:4-2f
4. Enum.Dist. I Location (Area) '
{[r j/�2�/',�` �''IA`�ItLvy9 aVl O 1�I I FEES COLLECTED
VALUAT ON SOURCE GA ELECTRIC WATER SEWE Ownership USE CODE
OF
9. UTILITIES Public ❑Private 0
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 ‘,2 ,,4'O
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 loc. law regulating construc '.n or the
performance of construction.SE REV SE SIDE FOR REQUIRED IN-PEP 10 • l Plumbing
/" s
DATE OF APPLICATION/0 /� `r'-� SIGNATURE OF APPLICA - i rlO Mech.
SPECIAL APPROVA ' SPECIAL CONDITIONS:
NAME DATE Plan Check _
Env. Health
SEPA n
Planning O
U
Mobile Home w
Fire Marshall
U .
Co. Engineer Other(Specify)
Utilities
TOTAL $
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
ilding Te ician PERMIT IS NONTRANSFERABLE //I g el (I `. .1 . ).j
PERMIT EXPIRES DATE ISSUED PERMIT-(V'O/ * 2 ?.POl'.F f.s.'