1980, 07-30 Permit 80-7902 Demo ResidencePLAN NUMBER
3c#d
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
LOT BLOCK SUBDIVISION
OW
3 I 1� r'l 42� ' IAY
ADD E5S
CONTRACTOR
4. Z°IS'S f'ni/�DLj11Oki
ADDRESS / '`' <
DESIGNER
rJ. ADDRESS
6.
PHONE
1971
ZIP
P�E D�
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S '� r�- — 08
Actual Set Backs in Feet
North ISouthO 1East (West
Size of Parcel
Type Const. OccupancY 1 Sprinklered
DYes ❑No ❑ Req'd.
Valuation
la� es -
Zone Classification
Building
gA�Area
__In Sq. Ft.
c C)
CHANGE OF USE FROM
TYPE
7. OF
WORK
ZIP
TO
❑ NEW ❑ ALT. ❑ AD'N. 0 RPL. ❑ MVE.
teBLD. 0 PLMB. 0 MECH. ❑ M.H. 0 POOL
(fr}�OTH E R
Main Floor I Upper Floors ( Garage Area Storage
Area of Decks I Finished Basement I Unfin. Basement
No. Baths I No. Stories
No. Rooms INo. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. '4 O 1 "
1OKI °� i i�KLEkZ X3
VALUATION SOURCE
OF
9. UTILITIES
GAS
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public 0 Private 0
Location (Area)
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 a p it does not presume
to give authority to violate or cancel the provisions of any other state or local la vy r gul ting constrjctiip i or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
DATE OF APPLICATION /f 4PV SIGNATURE OF APPLICANT
SPECIAL APPROVALS S ECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
p44,0
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ I
02* *1000
*10.00
* 1 0,00U
*0.00
790,1
07-3'0-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
O'7���50"-1810
DATE ISSUED
79'0;25
PERMIT NO.
.*10
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