1980, 06-20 Permit 80-6040 ShopPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBEP
2.
3.
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1. JOB
B(y/iADDRESS 0• I\1 V A.
LOT1 V t� BLOCK SUBDIVISION(,d
Ac I 6
OWN.EjR
ADpRE (/l' Ii 901\1Pr
CON RA 'TIO� U I
4. -r W
AD RESS
2 rN
I.�
DESIGNER
5' ADDRESS
rime
PH7--86 I Q
R!JONE
575 - '1
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S D
!st
Actual �Set
Backs in Feet
North W (South
Size of Parcel
Type Const.
Valuation
IOccupancy
East
'West
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area In Sq. Ft.
1.50
00
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
f>IEW
1PrBLD.
❑ ALT.
O PLMB.
ZIP
TO
❑ AD N.
❑ MECH.
DESC IBE WORK
8. 7�► �-- c% J
VALUATION
SO RCE
OF
UTILITIES
GAS
❑ RPL.
❑ M.H.
ELECTRIC
❑ MVE.
❑ POOL
WATE R
0 OTHER
iSEWER
EWA
1f Y16.
Main Floor
Upper Floors
Garage Area
Area of Decks
No. Baths
En
Finished Basement
No. Stories
No. Rooms
Storage
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
um. Dist. Location (Area)
Ownership
Public ❑ Private
SE CODE
Req'd.
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 _ �r
DATE OF APPLICATION
SIGNATURE OF APPLICANT
R`✓
SPECIAL APPROVALS
NAME DATE
Env. H
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui
SPECIAL CONDITIONS:
c rgic
�J o oaoM,/k L4�
121-40
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Rgq'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 62"+'
02* *6200
*62.00
*62006
E *0.00 8
5'84.52
06-16•-80
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'06�1'20181'0
DATE ISSUED
6.0r4,0 z
PERMIT NO.
*62,00a1-
TOTAL
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