1980, 05-07 Permit 80-4195 Demo Residence(PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LST
2.
BLOCK
3.
4.
OWNER
SOBDIVISFON
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUIVIER/S4 qc5 54 d
W /72 fib ',EXC• S. /i36'°
,ExC iI v 7 / ' UN/
7
ADDRESS J 6
vi
C NTRAAGTOR
ZIP
q.Z/G1
PHONE
�> 2G -9SS
ADDRESS
qL/ AJfJ
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
ZIP
PHONE
ZIP
TO
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POO
OTHER
Actual Set Backs in Feet
North South
Size of Parcel
Type Const.
Occupancy
Valuation
Main Floor;
L.4)4)
SCRIBE FORK
VALUATION
9.
SOURCE
OF
UTILITIES
/ , - . 2
GAS
4'LW
ELECTRIC
WATER
SEWER
Upper Floors
Area of Decks
No. Baths
East West
Zone Classification
Sprinklered
Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
/ 9vo
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. of Dwellings
No. Rooms
Req'd.
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 INSPECTIONS
DATE OF APPLICATION 41'� f —ge)
SIGNATURE OF APPLICANT A�!�.� J��►12
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Rec'd. Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
02* *30.00
*3000
419,4�
05-01-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Bui,14clingjec nic44/t
41
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
051-01'-80 419.55 *30,00
a.
DATE ISSUED PERMIT NO. TOTAL