1980, 05-13 Permit 80-4692 MH8.
V�ATI ON
e16—DOd o
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILt'INO CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3676
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
JOB ADDRESS
OT BLOCK
/ /
SUBUIVISI ‘7.4(idl add
O ER D
3. ‘ADDRESS
/!� gr1LC4Wf2,
ADDRESS (! p
e , 1/2DR /7z
CO TRACTOR
4. ADDRESS P.4.444
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZI P
49:�D
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S /',Z,-4.4-d/.2.(J
Lori .431..K 1
FA/rN ADD it/ re
Actual Set Backs in Feet
North / 4) (a ! ISouth ,.1)/
Size of Parcel
a 8 .k C}
Type Const. Occupancy
Valuation
Main Floor
iDe)K
Upper Floors
Area of Decks
A'',E•ENAC R,E5
East it) / (West )h'
Zone ClaplfIcation
Ctg�crr1D,��,,cgQ�
Sprinklered
Des ❑No ❑ Req'd.
Building Area inSq. Ft.
/DDT/
Garage Area
Finished Basement
Storage
Unfln. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
DESCRIB WORK
SOURCE
OF
TILITIES
❑ ALT.
❑ PLMB.
❑ AD N. ❑ RPL.
❑ MECH. ut M.H.
LECT R I C
❑ MVE.
❑ POOL
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Location (Area)
Ownership
Public ❑ Private (If
USE CODE
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 INSPECT! NS
DATE OF APPLICATION ‘6"-"—/
SPECIAL APPROVALS
NAME DATE
Env. y4�al�
Planning
9'6A
Fire Marshall
Co. En ef�
Utilities
°A -
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
6'
Req'd.
Rec'd.
Not Req'd.
x
FEES COLLECTED
Single
Building D 6 Ob
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 4.17)
PERMIT NUMBER
So— 4-C.,61
02* *50,00
*50,00 16
*50,006
B *0.00
469.1 z
05_13:-80
2 61479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building 11:,m(rn f�
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
DATE ISSUE
4'6'9. 2
PERMIT NO.
TOTA