1980, 08-04 Permit: 80-8084 ResidencePLAN-NUMBE! APPLICATIOWPERMIT
SPOKANE COUNTY BUILDING CODES DEPARTMENT
A NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
V APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LEGAL DESCRIPTION -SEE ATTACHED
167!-
LOT BLOCK ISUBDIVISION I PARCEL NUMBER/S
2. IS 1 6:3
OWNER
3. A"31 -
A DRESS
o. a
CONTRACTOR
-SAo,e
4. A�DDD,,,,��REESS
4-1�r<wc
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE L�'J NEW ❑ ALT. ❑ AWN. ❑ RPL.
7, OF
WORK 81BLD. 1-1 PLMB. ❑ MECH. ❑ M.H.
PHONE
5:�rr-3
ZIP
?qzli
PHONE
ZIP
PHONE
ZIP
❑ MVE.
❑ OTHER
❑ POOL
DESCFUB if WORK
VALUATIONSOURCE GAS ELECTRIC WATER
�J T
OF
9. ,�JLi O fJ a`7 UTILITIES
I hereby certify that I have read and examined this application an
on reverse side, and know the same to be true and correct. All p
type of work will be complied with whether specified herein o
to give authority to violate or cancel the provisions of any other
performance of construction. SEE REVERSE SIDE FOR REQUI PF
DATE OF APPLICATION SIGNAT ICA
SPECIAL APPROVALS
NAME DATE
lealth
Co. Engineer
Plans Examiner
SEPA Checklist
Buil in echnician
Actual Set Backs in Feet
North South 25' East /40 West 10d
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Val tion Building Area in Sq. Ft.
—34/00 0 �6y
Main Floor Upper Floors Garage Area Storage
Area of Decks Finished Basement Unfin. Basement
$6-e/
No. Baths No. Stories No. Rooms No. of Dwellings
z Z .7 r
CERTIFICATE Req'd. Recd. Not Req'd.
of EXEMPTION
Enum. Dist. Location (Area)
FEES COLLECTED
Ownership USE CODE
Public ❑ Private 13 Single $
d th 'NOTICE" provisions included
of I s and ordinances governing this Building #Z1O•D0
gra ing of a permit does not presume
loc law regulating const tion qr the
(` IrAWA , ? \ !) Plumbing
SPECIAL CONDITIO :
FEE AAip oiu 80 l ZS— Flo) 9
Naso
r NO/U iiv S Go it SFE f�7T��ff€A
e6vus i E0
�LLS�IpE/UC� `To �c
,9cc CV2 Aw�� �/i rpt e --,q 4c. r
A/d/V rEo 8�z-71 fid
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ G/Q cx->
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-04 r .4z *210.0COCL �--j -
DATE ISSUED PERMIT NO. TOTAL