1980, 12-23 Permit: M80B-5194 StovePLAN NUMBER APPLICATION/ PERMIT �/f PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
/ NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. �, C3 i5T
LEGAL DESCRIPTION - SEE ATTACHED
LOT I BLOCK SUBDIVISION PARCEL NUMBER/S
2.
OWNER PHONE
3. '`e C> F itC y -
ADDRESS
ZIP
Actual Set Backs in Feet
0. � (.
�
North South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
c
4.
ADDRESS
ZIP
Type ConsT7
Occupancy
Sprinklered
❑Yes [:]No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor I Upper
Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
Baths
No. Stories
No. Rooms
No.'of Dwellings
TYPENo.
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF �/ ❑ OTHER
❑ BLD. ❑ PLMB. R MECH. ❑ M.H. ❑ POOL
CERTIFICATE
Req'd.
Rec'd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
Enum. Dist.
Location (Area)
_
8 ,
FEES COLLECTED
to
VALUATION SOUROF CE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9. UTILITIES
Public ElPrivate ❑
Single $
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
Building
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
2 o v
-D
DATE OF APPLICATION SIGNATURE OF APPLICAN
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
SEPA
Planning 1
Fire Marshall
Co. Engineer
Plans Examiner
Id in Technician — PERMIT IS NONTRANSFERABLE
Mobile Home
Other (Specify)
U4* *7,00
*7.00 U
*7,006
H *0.00 00
51 9,32
12-23-80
6.479,
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
I
12,* 2 `3 -B'0 519 4 z
*Z00°1-