1980, 01-14 Permit: 80-129 ResidencePLAN UUMT,ER
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JOB ADDRESS
LOT BLOCK
2. ..�
OW ER
f
3. f
AD D R ESS
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CONTRACTOR
ADDRESS
DESIGNER
5. ADDRESS
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1 FType
L DESCRIPTION — SEE ATTACHED
SUBDIVISION UMBER/S �j .c /r �����
! rt Qi Jc ��PHONE
�-oNl� !si' AZIP et Backsin Feet
,7,,7 -South East WestPHONE el Zo a Classif'cation
ZIP nst. Occupancy i Sprinklered
PHONE
ZIP
CHANGE OF USE FROM
6.
TYPE NEW
7, OF
WORK ❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
/-Z Re
SPECIAL APPROVALS
REQ'D. RECD.
❑Yes ❑No
❑ Req'd.
luationQQ
Building Area in
Sq. Ft.
Co. Engineer
DWL Krea, Basement Area
Garage Ares
Storage
l7 /.�._-
Split Entry
Split
Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
Req'd.
Recd.
Not Re;
I
of EXEMPTION
-'u
DESCRIBE WORK ^
FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
O of
9,
6,49 QD4 Utilities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included 115'
on reverse side, and know the same to be true and correct. All provisions of laws and ordin ces governing this Building L,� _�-
type of work will be complied with whether specified herein or not. Th;�-,O%r,
anting of a pe it does not presume
10
to give authority to violate or cancel the provisions of any other state allaw regul ing onstruction or the
performance of constructtiion. � Plumbing
DATE //—/Y— 7 f SIGNATU _ Mech.
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE 4—,2- 21 OFFICIAL w&&J-1 '/
APPROVED FOR ISSUANCE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDAi
THIS BECOMES A PERMIT.
n ; —11' 4 .a$ 0'
PERMIT NUMBE- R —
DATE I-14—Fd
12* *29260
*29200 t6
*2920010
E *Q00 8
128
01 -14-8 0
a 6479
12,95 *29200:4�'-
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