1980, 04-14 Permit: 80-3466 Addition PLAN NUMB' "R v APPLICATION/PERMIT -'1-'-RMAT NUMBER
!G-1028 80 - 3 �
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SPOKANE COUNTYBUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
02 * * 134.00
JOB ADDRESS
1. 10821 E. 21st. LEGAL DESCRIPTION — SEE ATTACHED * 1 :224.0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S 2-2812 * 1 :, 4.0 0
2. 23,2L. 12 Cocoma Town Site 28542-2812
OWNER PHONE E * 0 0 0 u
c
3. Gary Herman 926-0742 C.07 23)24 11-K/Z Coco/Flo '22";(..,.%) S,re
R S ZIP Required Set Backs in Feet 3 4 6 5
AD
41021 E. 21st. 99206
North ,$'9 (south 119' East 2e° (west /a' 0 4- 1 l' —8 0
CONTRACTOR PHONE Size of Parcel Zone Classification
Hanson Clinst. Co. 928-7456 110 x 140 Aeaei. Sedat,e840'1 6 4 7 9.
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
N. 5309-.74j1livan Rd. 99216 frame V-N 2-3 ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE V ation Building Area in Sq. Ft.
Dewey Hanson 928-7456 f/8,soc. 808
5' ADDRESS ZIP DWL Area I Basement Area Garage Area Storage —
N. 5309 Sullivan Rd. 99216 6
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
TYPENo. Baths No. Floors No. Rooms Rec. Room
❑ NEW ❑ ALT. W AD'N. ❑ RPL. 0 MVE. / 3
7. OF 0 OTHER
WORK 0 BLD. 0 PLMB. 0 MECH: 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. Add 6' x 29'-8" addition behind garage, plus 20'-4" x 31' add, over gaa.ge FEES COLLECTED
ALUATION Source GAS ELECTRIC WATER SEWER
of
9.4, /It S-oc.), .ice Utilities
Single $
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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 x/3`1.00
type of work will be complied with whether specified herein or not. e granting of a permit does not presume
to give authority to violate or cancel the provisions of any other stat: o local law regulating c.,nstruction or the
performance of construction. Plumbing
DATE v/ Ad SIGNATURE /_ .wrr. . ' '� L '
Mech.
SPECIAL APPROVALS SPECIAL CONDITION,
DEPT. REQ'D. REC'D. Plan Check
Env.Health j C%tCC CO3vTRMC7[�/�
SEPA c
?II/iv S /C raCee
5-
Planning — wU
0".
Mobile Home rn
Fire Marshall z
Co. Engineer Other (Specify)
Utilities
Zone Clearance
PLANS A frgt0Ep yf l b(8D® TOTAL $ /3y Do
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
( — I4rr 6 6 1 3 nn. U* 1 3 4. 0 '0. -IL'
DATE 0/� OFFICIAL 9 c. ,
APPROVED FOR
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