1980, 01-31 Permit: 80-750 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NNNUMBERso 1
SPOKANE COUNTY BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 et * *7.5 0
JOB ADDRESS *7.5 0 to
/J,�Jr^ // LEGAL bESCRIPTION - SEE ATTACHED
1 LOT. -BLOT S%UB ISION PARCEL NUMBER/S *7,5 0 U
2 OWNER PHONE E * 0 0 O
3.
ErsZer f'2-,87f:57? Required Set Backs in Feet 7 4 9 2
ADDRESS ` L /Y "€'`� s� North South East West
S5-')._ 7 " i 7G� I ' 01 -31 -80
CONTRACTOR PHONE Size of Parcel Zone Classification 6 4 7 9,
-
NIODRESS ZIP Type Const. Occupancy Oyes ❑No Sprinklered
2.,V.b�
DESIGNER 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 ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK CIBLD. ❑ PLMB. ❑ MECH: ClM.H. CIPOOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK pp� i�
8. r2n(e ei-v- ik 9 FlL i l'(!��� ,a4-: P S ‘I, :1-6:: 1P ccs FEES COLLECTED
VALUATION ✓ Source GAS ELE RIC WATER SEWER
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
performance of construction. Plumbing
DATE SIGNATURE_ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health cC
SEPA o
I—
Planning — w
0
Mobile Home N
Fire Marshall 7'
Co. Engineer Other (Specify)
Utilities TOTAL $ 75~"
Zone Clearance
• WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ��``�� /y �� �� /�y� THIS MACHINE
$AVALI IT.U '7
DATEV.73(A�/ OFFICIAL �GQ.�YtJ4lQy`. ^t3.1� 0 O / 0 z � 5f).2-�
APPROVED FOR ISSUANCE 7