1980, 12-05 Permit: 80B-4526 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
- a — DEPARTMENT I 0 f 4 Co
20� � � � � SPOKANE COUNTY BUILDING CODES
/4) NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
�..// APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
02 * * 310.00
JOB ADDRESS _ LEGAL DESCRIPTION — SEE ATTACHED * 3 1 O. a U,
1 t LOT BLOCK AD-y.
SUB IfSION PARCEL NUMBER/S L6)c3 f,f * 3 1 0.0 0
p / d 02,3,57_: —
2. X...L YC.,� (.T �/:'L(.. �-Yt- ke 7 x/ (3 ILA--Q A * n 0 G c?
OWNER PHONE
3, r/..a!i2Y4'. 4-12.LY-vC %. it ..4GLI.-41. , o-,31--6 6n, 6K-0,4 A/.s A on a-7e N 4 0 3 z
a /,
ADDRESS ZIP Actual Set Backs in Feet /.
Q 3,3GS .e-----i-e_u__ ,A,ice-k-04_' 1,a q�.,2- ' Northhcl-Z/ 'South 7p East i /G�West 1 2=0 1 -8 G
CONTRACTOR PHONE Size of Parcel el , Z ne Classification/-y
4. n^^
4Ess ZIP Type Const. Occupancy prinklered
p(� ``✓ Dyes ❑No 0 Req'd.
DE SIGNG. S
DES PHONE V �nation � Building Area in Sq. Ft.
3i 7e,--- .4'i 9
5' ADDRESS ZIP Main Floor Upper Floors Garage Area Storage -
I/4 /-3 -- o 74.
CHANGE OF L 3E FROM TO Ar a of�KYre9 � Finished Basement Unfin. Basement
vN �v /393
No.Baths No. Stories No. Rooms No. of Dwellings
TYPE W NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE. 4 $p,�/�"
OF 0 OTHER CERTIFICATE Red. Recd. Not Req'd.
WORK 51 BLD. 0 PLMB. ❑ MECH. ❑ M.H. ❑ POOL
of EXEMPTION X
Enum. Dist. Location (Area) '
DESCRIBE WORK �1 ,q �1 �a I FEES COLLECTED
8. 0 4,L.tm --A1-1 /-/-21-6p., /. .�.,G, ,_ . .f=SE
V LUATI N SOURCE GAS ELECTRIC TER SEWER Ownership USE CODE
�� TILOITIES Public ❑Private pSingle $
included
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions �` `,C -
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building �` /d'—
type of work will be complied with whether specified herein or not. The granting of a permit does not resume
to give authority to violate or cancel the provisions of any other state or local law regulating construct' or the
performance of construction.SEE REVERSE SIDE FOR REQUIRED INSPEC ONS eJ Plumbing
- C
DATE OF APPLICATION / /_?6) m''�SIGNATURE OF APPLICANT ` A 11/4..11/4Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: A../C. /V.S/E 4k.
NAME DATE Plan Check
Env ea th '
/arm SEPA "-
Planning _
w
Mobile Home
Fire Marshall
Co. Engineer Other(Specify)
Utilitiese
TOTAL $ <3/0
Plans Examiner
124.-aWHEN MACHINE VALIDATED IN THIS SPACE,
� E P ecS7 v�ii6t j THIS BECOMES A PERMIT.
SEPA Checklist
I/ PERMIT IS NONTRANSFERABLE 121-�5 '� O: 4 5 1• 6 z *3 1 Q O a !J-
Bu[ ing['Tech cian r -79- `(/
I-
AA- ' �LZYI�(.L�' PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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