1980, 10-15 Permit: 80B-2004 Insert PLAN NUMBER APPLICATION/PERMIT
PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT I1 Fe -"2"0e
) NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESSU 6 * r. !,0 0
r ,it mss LEGAL DESCRIPTION - SEE ATTACHED
LO BLOCK SUBDIVISION
PARCEL NUMBER/S v �.3
2. ' ) 0 3 ±'
OWNER PHONE 1 C,_ 1 5_ a
r ADDRESS t� i r ZIP Actual
Actual Set Backs in Feet 6 /' ,7 Q
£-+ `c') a�dg i' iL( LQ. -11.1.- r 7 7+ k 3 7 North 'South East (West 4
CO�JITRACTOR PHONE Size of Parcel Zone Classification
3e5 A27Pki.-
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
{r(',( v ❑Yes ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP Main Floor Upper Floors Garage Area Storage —
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
No. Baths No. Stories No. Rooms No. of Dwellings
TYPE 0 NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
7, OF 0 OTHER
WORK 0 BLD. 0 PLMB. 4 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION •
,,DESCRIBE ORK . Enum.Dist. I Location (Area)
. (J� A 4 ^;� I FEES COLLECTED
8
`- VALUATION SOURCE 'SAS ELECTRIC WATER SEWER
OF Ownership USE CODE »
9. UTILITIES Public El 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 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.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
DATE OF APPLICATION / 'fT /7`?J SIGNATURE OF APPLICANC ' /.�-r..A..--�
l) Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Env. Health
SEPA 2
Planning O
CD
Fire Marshall Mobile Home
y
Co. Engineer Other(Specify)
Utilities /'
TOTAL $ �.
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Budding Tec nicia c PERMIT IS NONTRANSFERABLE Pl.
Q r,4i.5L.8i.a 2 0 Q 4_Q *7. 00 Q a -
a 11 if4 PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL