1980, 01-04 Permit: 80A-9776 Remodel PLAN NUMBER APPLICATION/PERMIT PE1ia::T-IrLiMBER• I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 9'7 l
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE 1 — --0
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
C, 2 * * 2500
JOB ADDR�S ��� LEGAL DESCRIPTION — SEE ATTACHED * 2 F 0 0
LOT BLOCK SUBDIVISIO PARCEL NUMBER/S a5,,,,{.i�2 _.1�., A"
frrf-/. f0 KoKo/40 re 44)M,5fre 44Ts >o.- es,,,e).--ii- 3 * 2500 Y
OWNER PHONE /D
3. iea..44,-e...L4.../ X, .J I;2.9—.2/0 K0K6 o E * 0. 00
DDRESS -- Q ZIP Required Set Backslin Feet ✓ 9 7 7,5
i`f .. /1 //) 5l -d ..T// G�,ersL2� a S
North , 'South $7 i East '7�� 3
'West / 0 1 —0 4—8 0
CONTRACTOR PHONE Size of Parcel Zone Cla,ssification
4. .0_,/44.1.-- 24C - ,l t ' .9hJ— 2 6 4 7 9,
ADDRESS ZIP Type Const. Occupancy Sprinklered
Q.e��4 ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I Basem- ent Area GaragearArea Storage —
J...6-.1-J
CHANGE OF USE FROM TO Split ,ntry Split Level Rancher
6. f —
No. Baths N . Floors No. Rooms Rec. Room
TYPE El NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. ,fir ) f —
7. OF UCJ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH: ElM.H. El POOL f , ? CERTIFICATE Req'd. Rec'd. Not Req'd.
, ,j�rL :c of EXEMPTION X
DESCRIBE WORK
FEES COLLECTED
8. ear.�dl.-�.�_,,-9 .�t,vfie/ /2-4.-7,-X-0-g:
VALUATION source GAS ELECTRIC WATER SEWER
�/7 of
9.5,/.5-0./.1 Utilities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included AvU
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 s a': or local law regulating co .truction or the
performance of construction. / / / Plumbing
DATE /.....2--..'2.-7--%9' SIGNATURE f —. a �✓ Mech.
SPECIAL APPROVALS SPECI' CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health / ���)� 4,q:,24 �'i __ __ "C� cr
�j
.-�/ z , ;r ' SEPA
t.C ._
Planning r � — i_.t
Mobile Home cn
Fire Marshall z
Co. Engineer Other (Specify)
Utilities TOTAL $ a`�
Zone Clearance
M' WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist 1 —3— .F d THIS BECOMES A PERMIT. (} (�
DATE OFFICIAI Mai/i fr\aL77Z4..1 0 1 -0 4 —8 0' 9 '/ 1 7, 6 Z * 2 5, 0,0 !-
APPROVED FOR ISSUANCE
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