1980, 02-21 Permit 80-1420 MHPLAN 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 4 COPIES
JOB ADDRESS
• N, /'*/o 5A1Z ;5..Ni ROAb
LOT BLOCK SUBDIVISION s, 150 i �a� %-r ro, Bloc t z
v Prc14)NscN's ADpl'rli/j /
OWNER
3. JERR.I pt. Do&SON
ADDRESS
4.
rJ. ADDRESS
N 14:z2 siNggEnrr /zoAD
CONTRACTOR
ADDRESS
DESIGNER
PoK►t107..
PHONE
92-1•/-67711-
ZIP
992o6
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S /85 4l. 1 Oz p*
Required Set Backs in Feet
North (South 53 East 6/. S' West
Size of Parcel Zone Classification
12. - 43'X 15o' AGRIGIALT4RAt
Type Const. Occupancy Sprinklered
v-N it'-3
❑Yes ❑No ❑ Req'd.
Valuation DO Building Area in Sq. Ft.
1 t.
DW Area
c 2',
asement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
PHVVEW 0 ALT. 0 AD N.
❑ BLD. ❑ PLMB. ❑ MECH:
❑ RPL.
Wrrit.H.
❑ MVE.
❑ POOL
❑ OTHER
Split Entry
No. Baths
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
Rancher
M 9ILI� f�ni ir,
No. Rooms
I Rec. Room
5 HNE
Req'd. Req'd. Not Req'd.
v
DESCRIBE WORK
8 MORLLE. I4oME, (its-0b As SIAV.h1Cg.
VALUATION Source GAS
9. '�/�o/DUO jp Utilities
ELECTRIC
F f1
WATER
SEWER
SFPTI�
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.
DATE ,a7" 7i /2'', SIGNATURES
DEPT.
SPECIAL APPROVALS
REC'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
� N MkP. D
DATE
0 FICIAL
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
504
rya
V C,
TOTAL $
Other//())Specify)
PERMIT NUMBER
DATE.4(.IJ/ 1.3/ 1c'79
q7* *100m0
* 1 00.00
* 1 00,006
f *0.00 8
1 41,8z
02-21-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THISdFCOr AMMIT. 1 4 1 9 z k l O O O a
AP'R! ! FOR ISSUANCE
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