1980, 10-28 Permit: 80B-2788 InsertPLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
v
APPLICANT:
COMPLETE NUMBERED SPACES - PRESS
HARD TO MAKE 3 COPIES
6.
JOB ADDRESS
I
LEGAL DESCRIPTION - SEE ATTACHED
/-,
No. Stories
No. Rooms
No. of Dwelling
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
LOT
BLOCK
Req'd.
Recd.
PARCEL NUMBER/S
y
2.
WORK
of EXEMPTION
ISUBDIVISION
%PESCRIBE WORK n Enum. Dist. Location (Area)
FEES COLLECTED
O NE
PHONE
OF v
9. UTILITIES Public ❑ Private ❑
I
Single $
1 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
to give authority to violate or cancel the provisions of any other state or local law regulating constr ,ion or the
3.
Plumbing
DATE OF APPLICATION j� c.� � SIGNATURE OF APPLICANTS �
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DRESS
NAME DATE
ZIP
Actual Set Backs in Feet
SEPA
Planning
NorthSouth East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4'
1AD RESS
ZIP
Type Con7
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
Main Floor
I Upper Floors
Garage Area
I Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement i
Unfin. Basement
6.
I
No. Baths
No. Stories
No. Rooms
No. of Dwelling
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
CERTIFICATE
Req'd.
Recd.
Not Req'd
El BLD. ❑ PLMB. IQ MECH. ElM.H. El POOL
WORK
of EXEMPTION
%PESCRIBE WORK n Enum. Dist. Location (Area)
FEES COLLECTED
$
VALUATION SOURCE G ELECTRIC WATER SEWER Ownership USE CODE
OF v
9. UTILITIES Public ❑ Private ❑
I
Single $
1 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 constr ,ion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTI NS
Plumbing
DATE OF APPLICATION j� c.� � SIGNATURE OF APPLICANTS �
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
SEPA
Planning
neer
Utilities
Plans Examiner
ing Technician. y PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Mobile Home
Other (Specify)
TOTAL 7 —
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 --ai 2., & i- 8' 0' 2 7 9.0 z
DATE ISSUED PERMIT NO.
r.,
*7.00a1-
TOTAL