1980, 01-11 Permit 80-0099 Add to ResidencePLAN Nl1,MBER
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
LOT BLOCK SU iDIVISION
O)NNER
-aQ ,44A/ —ca'
ADDRESS
.7g+a.c'66' [IAyoid
C NTRACTOR
AD RESS L
DESIGNER
rJ. ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
9a��%o9
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER'S /7.4"S
Ws. J&G) 0/. 1,3kk 1'9'0
CRC HARP A vE/ A. D'a'
Required Set Backs in Feet
North 1 (South 34
Size of Parcel
/ 9 D / )(
Type Const. Occupancy
Valuation
DWL A/ea I Basement Area
/,�
p
East /•8
S
West
Zone Classification
prinklered
❑Yes ❑No D Req'd.
Building Area in Sq. Ft.
Garage Area
Storage
Split Entr Split Level Rancher
TYPE
7. OF
WORK
51 NEW
❑ BLD.
❑ ALT.
❑ PLMB.
4 AD N.
0 MECH:
❑ RPL.
❑ M.H.
O MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
1
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESC BE„WORK
8 ('/ .eti "ALUATIO
9.
Source
of
Utilities
/! 4l'Vl1rT^
GAS ELECTRIC WATER
SEWER
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 Ioc law regulating construction or the
performance of construction.
DATE / t3 SIGNATURE *
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
C(61444-e-
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDIITIONS:
DATE /00 OFFICIAL
APPROVED FOR ISSUNC
FEES COLLECTED
SingledO
$
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
l
TOTAL $ lo.�
PERM,T IJuiv.r:ER
80 - oC—
DATE
02* *62,00
*62.00
*62.0(M
E *0.00 8
9.8g
01-11-80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Lej, . BECOMES
9,9f *62,00ai-
•
•
SX/sr/Nc
R/'.s/aFNCs
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