1980, 08-28 Permit App: 80-9243 Residence, Garage, DeckPLAN VB 4C-416
P.)
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
JOB ADDRESS
qcT
LOT
BLOC
K
/MM ARoN Dg111E
SUBDIVISION
PoNDE-RosA AcF,s
LEGAL DESCRIPTION — SEE ATTACHED
7 TN ADPITIOI
OWNER
3. 6 -1419 -1 --
ADDRESS
MOoRE
PHONE
`12Ht— (?2,72—
PARCEL
'2 2.
PARCEL NUMBER/S 325'/S- Dto1
Cf723
CONTRACTOR
WAKzU-. sPr?kANE
4. ADDRESS
EN TY�PPJSLS
ZIP
`i92o&
PHONE
3'�7z
Actual Set Backs in Feet
North (South
East 'West
E , C1 1Z,3 S'PPAGUE -SPoKAN6
DESIGNER
5. ADDRESS
ZIP
1c/2o�
Size of Parcel Zone Classification
A l93 AG12,,1cucrug1+L--5Uf-)
Type Const.
U -N
Occupancy Sprinklered
—3
oyes ❑No ❑ Req'd.
PHONE
Valuation 00
ZIP
CHANGE OF USE FROM
6.
TYPE
7• OF
WORK
TO
CJ NNEW ❑ ALT. ❑ AD N. 0 RPL. ❑ MVE.
LJ BLD. ❑ PLMB. ❑ MECH. 0 M.H. ❑ POOL
❑ OTHER
Main loor
156
Upper Floors
Building Area in Sq. Ft.
Z Slo
to ilrau.EPecks
2 /6
No. Baths
3
Garage Area
'72y
Finished Basement
5'7; 5—
No. Stories
No. Rooms
Storage
Unfin. Basement
'x'2.:5
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. R1✓.SI De4cE.- C7
VALUATION
t62-11o`f
X21 xrr U Nc,o a g<Ep
U>r
1414)7,r2._.- DEZKS
SOURCE GAS
OF
UTILITIES
ELECTRIC
FA
WATER
Enum, Dist, I Location (Area)
SEWER
5EP7ic�
Ownership ,✓
Public 0 Private
USE CODE
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 regulating construction or the
performance of construction.ionSEE REVERSE SIDE FOR REQUIRED INSPECTIO S
DATE OF APPLICATION ZJ�� —� SIGNATURE OF APPLICAN
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
-7/),y)?,,
Pla g
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
"Ti) 61 P3sTL'I,t1Klr
SEPA Checklist
Building Technician
TO Ttf•W rr
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 322.
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
7Do
TOTAL $ 32,2 nr
r'
PERMIT NUMBER
02*, *32200
*32200
*32200
E *000
92421
08-28-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08.-42Ve;8-0 9'2'435 *322.002- -
DATE ISSUED
PERMIT NO. TOTAL
FILE COPY
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