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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