1980, 10-14 Permit 80B-1977 Soft WaterPLAN 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
JOB ADDRESS
LOT
2.
BLO K
3
ADDRESS
SUBDIyISION
Lttk
CONTRACTOR
r 1I
4. ADD ESS
DESIGNER
PHONE q g
ZIP /I
9,/1AC0
PHONE
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
DESCRI E WORK
8. ♦.u.' I./y.
❑ ALT.
PLMB.
ZIP
20
PHONE
ZI P
TO
❑ AD'N.
❑ MECH.
d
VAL ATION
9.
SOURCE
OF
UTILITIES
❑ RPL.
❑ M.H.
ti err
GAS ELEC RIC
❑ MVE.
0 POOL
WATER
❑ OTHER
SEWER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const.
_East
Occupancy
Valuation
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor Upper Floors Garage Area
Storage
Area of Decks
Finished Basement Unfin. Basement
No. Baths
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist, I Location (Area)
Ownership
Public ❑ Private ❑
Req'd. Rec'd. Not Req'd.
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION /O-/-?4 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single
Building
Plumbing 4,3
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$
TOTAL $
PERMIT NUMBER
C *3.00
*3.00
*3,006
A *0,00 8
1 97.6g
10-14-80
2 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
rii r rnDV
B ilding Te hnic n
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
l 0 -1'4'4°'8 0
DATE ISSI IFII
19.7.7z
PPR5AIT Kin
30 0 a IJ-
TO AI