1980, 06-13 Permit 80-5785 MH(PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBEk
c5C- 5 785
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. IJ, i S"ZL..
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
2.
OWNER
3. B po
ADDRESS
E . 1Z1tZ
CONTRACTOR
4. ADDRESS
SUBDIVISION
`>ow�l►v c-�
At>
PHONE
ZIP
CiakC_,< <o
PHONE
ZIP
gPARCEL NUMBER/S i. 1 sG I r �jZ�1 1C�• �.13C�
EJ(C• ..SCI 0 iz T•J t3o.
CY7553-1343
Actual Set Backs in Feet
North 135` 'South C.-SS(
Size of Parcel
o
Type Const.
Occupancy
East '(D( (West Z-(0I
Zone Classification
f4.C_� 21�c
Sprinklered
❑Yes ❑No D Req'd.
DESIGNER
rJ. ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
,yaluation
c?OC7. C
Main Floor
Gev
Area of Decks
Upper Floors
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
TYPE
7, OF
WORK
KNEW 0 ALT. 0 AD'N.
0 BLD. 0 PLMB. 0 MECH.
❑,r RPL.
NJ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
1 J
CERTIFICATE
of EXEMPTION
No. Rooms
Req'd.
No. of Dwellings
Rec'd.
Not , q'd.
DESCRIBE WORK
s. SWEl Le, W t r)E
VALUATION
98;000
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Enum. Dist. I Location (Area)
I
Ownership vl USE CODE
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 pr•sume
to give authority to violate or cancel the provisions of any other state or local law regulating construct' r the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION 6.-/3 - V ff SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
lann ng /
Fire Marshall
A 5/m
Co. Engineer
Plans Examiner
SEPA Checklist
- PL_A G Elm
tv)0 13 cC_c Ac5cA•.�
6)CtS-T(I CY e
(9,/,c/,,e44724
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
444
Mobile Home "Gp,-k
Other (Specify)
TOTAL
.07'* *50.00
*50.00 V)
'*50.006
E *0,00
57a
06=134-80
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Bul in echniician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
'6 1.- -8,0
IIATP ICCI IFII
578,5z
*50,00°-
DCQrAIT Ain Tl1Tn1
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