1980, 08-27 Permit: 80-9204 ResidencePLAN NUMBER
APPLIKM • ON/PERMIT
8/2 7/a SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
4.
JOB ADDRESS
�. /0 -?.r_3 -_s 32 ^/o e-. /D 769'
LOT
/41
BLOCK !SUBDIVISION
53 1 ,kc , c,n o .7pw,Vs / r65
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
/ cX,'3 cf f;1GC//%I/ft)
u.�
PHONE
53..T.3oi
PARCEL NUMBER/S
5€E /479AG/ic� tri �4G
P74 Of 2855/3-53/7
ADDRESS
P. 0. 2On
CONTRACTOR
ZIP
99e//
Actual Set Backs in Feet
North Goa !South 25 !East 2G,' 'West /0'
PHONE
Size of Parcel Zone Classification
/2 A' �S5 i46R/ 561c3c-1.4B,9i1./
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
ZIP
Vp.�u� n
/3�•/-7/ Opo
Main Floor
Sro�/
Building Area in Sq. Ft.
86c/
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
4/52_
Unfin. Basement
TYPE
7, OF
WORK
EY1 NEW
NJ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
D MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
Z-7
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not/Req'd.
V
DESCRIBE WORK
FNm / c. t-/ !RFS/ r ivice
Enum. Dist. I Location (Area) T
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
//C
Ownership
Public ❑ Private e'
USE CODE
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
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 construction or the
performance of construction. SEEjREVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATIONZ1p/1 SIGNATURE OF APPLICANT �r a
SPECIAL APPROVALS
NAME DATE
Health / /
/6' 0 /I so
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building echnician
9 Nj ?c y 04/s,
SPECIAL CONDITIONS:
FEE Pi4/0 ON
It 'O- 6870 (.5Ee 4774 cii'D)
APPRO t" d P 7Ht,s P&ie.,1/ r' /s sa 3 7 --
Ha
-HCL 6e/tip/Vela c ' zC, f ,e/ic`" (' P &'»y
/69)74 ,0 94' Lar- Zwt / J srei r_;
1%-S/Ocr/cc _7 ;0E cc5"/sr,4.4rc 0 /r✓
Accra2,o4.vcE w/ rH /I� 3/rE
P6/9i1/ ,Dr1 r60 6/07/8c,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building $0/0.00
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 2/0 . bO
PERMIT NUMBER
80 — CIc 04-{
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08_27-80
DATE ISSUED
C' 42 *21o.0o°F
PERMIT NO. TOTAL