1980, 01-15 Permit: 80-275 MH PLAN i\IUMBER APPLICATION/PERMIT PERMIT NUMBER —I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT Sd -2 7�"-
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE % `/Ga ad
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 2 * * 1 0 0 0 0
JOB ADDRESS �, 0// /3 TN q
1 ��'
1, LEGAL DESCRIPTION - SEE ATTACHED
100,00
LOT t LOCK SUBDIVISION PARCEL NUMBER/S 2.-1/S33 ,—C c' Z2 * 1 0 O,0 0 U
zT�t2� 2-77-/-K41-,..., /4l�fl�T�o moi, 6,e. 7�ac^�.412
3L J
OW` ER ,/ PHONE E *0.0 0 8
a a�a e- m!4¢K t=t— pZ5'.....000 (4 715 20 1-2/ 83ETTMAAi A DD
ADDRESS ZIPRequired
/ Required Set Backs in Feet / ` 2 7.4 L
I Z Z 0 i(-t7'� Rs T i 1g-{t91� !2 D , 9'?Z® }ca North `✓�` 'South �� East 4�S (west ys 0 1 - 1 5-8 0
CONTRACTOR PHONE Size of ParcelZone Classification
N - k. gD , _colt/%-f /Z ( /3 5' iq6e/, Su 13 I 6,4 7 9,
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
S/Q-/'" ( ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE V luation C 0 Building Area.in Sq. Ft.
e2/I 0 D D' /6 'D
5. ADDRESS ZIP DW rL Area I Basement Area Garage Area Storage —
/6�0
CHANGE OF USE FROM 'TO Split Entry Split Level Rancher
6. No.Baths Floors NRooms Rec. Room
TYPE Xl.,NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER /
WORK ❑ BLD. ❑ PLMB. ❑ MECH: RI M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION X
DESCRIBE WORK
8. /-(15//3-;%jl/ L ///6 9/'-?1 / 4
j€ c9 it, FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
9. ZQ,Cy-D-D. Utilities trv,Y` , ww? S-LPT Single $
9 -
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 I. al law regulating construction or the
Plumbing
performance of construction. _.,..-- j
DATE /Z - G - 7 SIGNATURE '� aim.-- . . A
Mech.
SPECIAL APPROVALS SPECIA CONDITIONS:
DEPT. REQ'D. REC'D. C Plan Check
Env. Health 0,----"• ' -lId1—O J
/42-—fig—79 SEPA
Planning o _ w
/41191 :"-- c-
Mobile Home / cn
Fire Marshall 7
,
Co. Engineer Other (Specify)
Utilities TOTAL $7,50,
Zone Clearance .
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ,,1 � �� THIS,BECOME .R PRMIT. 2 ci o F'
�DATE/6' IU OFFICIAI J lli —� " b'�' L �� 5 :-_ * 1 0 0, 0 0 �.
APPROVED FOR ISSUANCE _
2 j
® THIS AREA FOR USE BY APPLICANT FOR LEGAL
TAX SEGREGATION APPLICATION FORM DESCRIPTIONS AND DRAWINGS. USE REVERSE SIDE IF
NEEDED.
(Applicable to the division of one or more parcels of real property into 9 t-7-j,t/AN> /1 pi) G 6;-r% / 7'///7u ,9,c_ '
two or more parcels under different ownerships, also applies to ,
aggregation of parcels.) Ji. L_ JLC. !1 /- r p :z;� ,��1 L/-T
NAME Li-,':_s..-_ F• /7/7/ (-77=
ADDRESS _' �1 kc:.
NUMBER-`-4^Y C c c `% DATE)1, -L• - '7<i
h.
DELINQUENT /3-/� `/5 //_/7 `/" /7
TAXES _y .� _,,,L PARCEL NO(S) 67 41�3 - O�I,R3 / c7 '6 G
'' Q�.e.-/7Xe. ?
' c:c!.
I `•,;'Enter legal descrtf•s` ,pf nts,, be segregated. Also
,.-iK'4 de lega)c,cksei'iptu '-of x ttonsi maining (use supplemental 1
'sheet if 1Lded) ., �)
' ! 0 .t1 shytt.nil /1/
II. Make drawing bf it e(property. Indicate approximate dimensions 1 j�
-,of ,.ppoptrx r,;°-7ities. Indicat on which portions of property any , )3 - — t9
,, - •ings h uld copy of a survey is available, please
attph tro th�s,fp ,
III. This +0': ' atiddats to be om ted in it irety before processing. ,
-- -__17------ 0-O - 1 owr_a
NOTE: The approval of this application by the County Assessor or his p� r52-t v r�,4,/e e r
appointee shall not be construed as authorizing the division of lands for /.^ , , ,
. /17,",,41, a/v a %
the purposes of sale or subdivision in violation of RCW 58.17 (Plat and
Subdivision Act). The taxpayer is hereby advised that no segregation I t
will take place until this form is completed. 5
' - �_ _�- �__ .. . . `� _ RECEIVED �Sr 510 �3 020q -6 .3— � `f
aA+�E o
7.
v f
Applicant ,ignature DEC 6 1979(f)
_ y n�;r, �'
ASSESSOR �3,-T?
V
/
asp
-
I
-74 /3s `
Aor 20 1627-
Co' 27-60' /1'
/log