1980, 06-04 Permit G80-5360 MH HookupPLAN NUMBER
.101
APPLICATION/PERMIT
SPOKANE COUNTY --- BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS �—t-
1. /7.20 -,/71a
2.
3.
4.
5.
LO11(
LOCK
SU IVISION
rzl G--
OWNER
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ADDRESS
CONTR TOR
AD ESS
DESIGNER
ZIP
P) ONE
1o2s� s`ss<�
ZIP
North
Size of Parcel
Type Const.
Actual Set Backs in Feet
'South East
Occupancy
West
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
9.
TO
❑ NEW ❑ ALT. D AD'N. ❑ RPL. 0 MVE.
❑ BLD. 0 PLMB. MECH. 0 M.H. 0 POOL
DESCRIBE WORK
VALUATION
SOURCE
OF
UTILITIES
GAS
�� X
ELECTRIC
WATE
0 OTHER
SEWER
Area of Decks
No. Baths
Finished Basement
No. Stories
No, Rooms
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑Private ❑
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 INSPECTION?
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
Req'd.
SPECIAL CONDITIONS:
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mec
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
1/✓
04* *4.00
*4,00
E *6,0069
5359�
06-04-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
rill r 'Sri III/
Bui ' g Tech c
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0C-04`-80
DATE ISSUED
53.6,0 z
PERMIT NO.
*4.00ELF
TOTAL