1980, 12-18 Permit 80B-5071 Special InspectionPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3676
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
. r- I -di �Krl'lt\-1'
LOT
BLOCK
SUBDIVISION
OWN R
3 O hJ N 14
ADDRESS 1`
4' ADDRESS
PHONE
534- -
ZIP
CONTRACTOR PHONE
DESIGNER
ZIP
PHONE
ADDRESS ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel
Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
Main Floor
Upper Floors
CHANGE OF USE FROM
6.
TO
Area of Decks
Garage Area
Storage
Finished Basement Unfin. Basement
TYPE
7. OF
WORK
❑ NEW 0 ALT. ❑ AD N. 0 RPL. ❑ MVE.
❑ BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
❑ OTHER
No. Baths I No. Stories
No. Rooms INo. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd. Not Req'd.
DESCRIBE WO
8.
VALUA ION
9.
16
L
SOURCE
OF
UTILITIES
GAS
ELEC RIC
(�- Ic1'b-
WATER
Enum, Dist.
Location (Area)
SEW R
Ownership
Public 0 Private 0
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
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIO. NS: /
ijT146 Ci°J otc1el.50
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Oth:r (Specify)
TOTAL
'02* *8.00
*800
*8006
E * 0. 0 0
8966
08-22-80
z 64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
B 'ding
chnician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
510 7' 1'2 0:'2)1
DATE ISSUED PERMIT NO. TOTAL