1980, 06-17 Permit: 80-5857 ResidencePLAN NUMBER
APPLICATION/PERMIT
Building
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
Plumbing
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS
HARD TO MAKE 3 COPIES
JOB ADDRESS
SEPA
Mobile Home
LEGAL DESCRIPTION — SEE ATTACHED
LOT
I BLOCK
SU.OIVIS ON r
_
PARCEL NUMBER/5.,offR_2.^
x
C�C�T I'le)
O ER
PHONE
3. .r ,
/r�/,#1i-)ik1Y14AF
-
ADDRESS
ZIP
Actual Set Backs in Feet
o'_�
North South East West dL>
CO TRACTOR
PHONE
Size of Parcel
Zone Classification.
4.
AD RESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main loorrs
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
TYPE NEW ❑ALT. El AD'N.
�
❑
11 RPL. MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwellings'.
7, OF
❑ OTHER
�� r~
CERTIFICATE
Req'd.
Rec'd.
Not Req'd.
WORK ❑ BLD. ❑ PLMB. ❑ MECH.
❑ M.H. ❑ POOL
'
of EXEMPTION
DE.SCRIBEWORK
Enum. Dist. Location (Area)
8. a f
V LUAI �IQ'_4TSOURCE GAS✓ ELECTRIC WATE7 SEWER
/I OF Ownership USE CODE
)"� UTILITIES Public ❑ Private
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 law r lating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICA1451r " �� SIGNATURE OF APPLICANT^
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
i. HealthAk - �11�
nning
Co. nc'n r
if/ .
Utilities
Plans Examiner
iOM Y20,STTL M)Arr
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
$
Building
ry
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
I. Rr MI: NUMBER
C`2* *28200
CC *282',00:
C_
585 b`
06-17-80
6.479.
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05,_1, _80 � ;i5.7'� *282,00°-
DATE ISSUED PERMIT NO. TOTAL
I
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PM,
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