1980, 01-11 Permit: 80-116 AdditionI
PLAN NUMBER APPLICATION/ PERMIT
SPOKANE COUNTY - BUII-b NGICODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JO ADDRESS
,- '2C" � 2- - LEGAL DESCRIPTION - SEE ATTACHED
OT BLOCK SU � l
PARCEL NUMBER/S �-<3
2. 1? 0 �r ^W,,. 1 oP,
OWNER T
n
PHONE
3. —1 . VV
ADDRESS Sr �7-Tl'
d
ZIP O�
CONT ACTOR
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PHONE
4. ADDRESS
Z
DESI�;NER
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16
5.
ADDR SS
ZIP
CHANGE OF USE FROM
TO
6.
TYPE
NEW ❑ ALT. VA ❑ RPL.
❑ MVE.
7 OF �❑
WORK LD. ❑ PLMB. 1:1MECH: 11M.H.
❑ OTHER
❑ POOL
rcequired Set Backs in Feet
North T� 2 (South
Size of Parcel
Type Consi. Oc pancN
Valuation
DWL Area Basemen -Ar
M� 3�
Sl5lit Entry Sr
No. Baths No. Floors
CERTIFICATE
of EXEMPTION
East 'C- West
Z ne Classification
F --',G, R3 -
S rink ere
❑Yes No El Req'd.
Building Area in Sq. Ft.
Garage Area Storage
LevelRancher
_T
No. Rooms j
Rec. Room
Req'd. I Recd. Not Re,
8 I --t � /�1� FEES COLLECTED
VALUATI N Source I IGAS EL CTRIC WATER SEWIR
9 of
C.�C,�LI Utilities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions i
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governBuildingtype of work will be complied with whether specified herein or not. The granting of a permit does not to give authority to violate or cancel the provisions of any other state or local law regulating constructioperformance of.,o/nstruction.Plumbing
DATE Z �l/� SIGNATURE ��-,AT� �`�T�%/''Mech.
SPECIAL APPROVALS
DEPT. Q'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR
NCE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $�
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
L
PERMIT NUMBER
00 •`-_ /%
DATE
C2* * 1 52.00
*15200:
E *Q(')ti u
1 1.5
01-11-�•0
6.479.
PACE,
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