1980, 09-18 Permit MHPLAN NUMBER
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
NB ADDRESS
LO B OCK
I.S i
OWN R
3
DD
ESS
//
CQNTRACTOR
4. L1tiYti?
A D`,R_�EIS'S
.,_r�1/Y[�4Lr"
1
4,
SUBDIVISION
/
Lai _
I .40.41./
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PHONE
q 2k—../) 7<3
ZIP
PHONE
ZIP
PHONE
ZIP
TO
❑ AD N.
❑ MECH.
❑ RPL.
M.H.
❑ MVE.
❑ POOL
❑ OTHER
RI
CM�C R�'r Al �1i
„lie VALUATION
9. 90 G) l
SOURCE
OF
UTI LITIES
GAS
ELECTRIC
WATER
SEWER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S �i/,5 �3! v� j.24)
/Vy2 tors / /) /3J
/1/L'ULAY' A bp,
Actual Set Ba/cks in Feet /
North 5 Southi3G East
West
Size of Parcel /
4-:)k-') X 1
Type Const. I Occupancy
Vaation !/G
cf -
.fi"U
Main F1Ioor,Upper Floors
Area of Decks
Zone Classifica Io▪ n •
,Q.(1. �)"�N/�.d l t( Y4,41,4-'>
rI Sprinklered
I Dyes ❑No 0 Req'd.
Building Area InSq. Ft.
0
Garage Area
Storage
Ini hedement Unfin. Basement
1
i.
No. Baths No. Stories
CERTIFICATE
of EXEMPTION
No.
Rooms No. of Dwellings
Req'd. Rec'd. Not Req'd.
Enum. Dist.
Location (Area)
Ownershlp
Public O Private ot
USE CODE
I liereby 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 permi oes not presume
to give authority to violate or cancel the provisions of any other state or local law r Latin c nstru tion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO I
DATE OF APPLICATION e —
SIGNATURE OF APPLICANT /`
SPECIAL APPROVALS
NAME DATE
Env. Heal
h
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
6a /w
/ y 4 y�?^
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �So DO
eRMIT NUMBE
3 0 7
07* *50,00
*5000 bi
47.3
09- 18'-80
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
h*h
ding Techni n
61.4-etCit
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
'4 7.
7z *50;00°�
DATE ISSUED PERMIT NO. TOTAL