HomeMy WebLinkAbout1980, 07-01 Permit: 80-6581 ResidencePLAN NUMBER
7 y il. -v i2 —.Z00
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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
JOB ADDRESS
1. L serertOC`
2. J
OWNER
SUBDIVISION
/710/4.4-341r.
3.ie—R (,'A/Si C L?
D R ESS
f 3d, 1Y!JX /412/7 . /Y/T0r/1//i7
CONTRACTOR
5''fi-
4' ADDRESS
4
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
PHONE
922 3& 11
ZIP
HONE
Required Set Backs in Feet
North_ 'South
Size of Parcel
x >HO
DESIGNER
5. ADDRESS
ZIP
PHONE
ZIP
CHANGE OF USE FROM
6.
TO
Easy -.7^ (West
Type Const. LOccupancy
aRani / ,-7..,
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V
V a l u a�tpiolI n .NFF✓yy✓
ItWIL`IArea aseMent Area
iZ op.
Split Entry
Zone Classification
S i" . A'/ss
Sprinklered
Lives NtNo ❑ Req'd.
Building Area in Sq. Ft.
GaKage Ares
Storage
Split Level
Rancher
TYPE
7. OF
WORK
XNEW
BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No.7Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Rs4'd.
8. DR BE�pilaK ow N
VALUATION
9.
Source
of
Utilities
AS
ELECTRIC
1-N�-iftrU
WATER
SEWER
Cot.'.vr7
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 I. : _ ating construction or the
performance of construction.
DATE —7-71::7 SIGNATU
DEPT.
Env. Health
Planning
SPECIAL APPROVALS
REQ'D. REC'D.
Fire Marshall
Cog .ee'
Utilities
Zone Clearance
-1-8v
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
DATE % "/ —Eck,
i / —
— is
6 c; 7 9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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