HomeMy WebLinkAbout1979, 09-26 Permit: 79-4742 Renewal of N0781 AdditionPLAN NUMBER
APPLICATION /PERMIT Cz9
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1.
JOB ADDRESS
�
. A19 A
LEGAL DESCRIPTION — SEE ATTACHED
BLOCK
�I
SUBDIVISIO
2.r-to
J"6N-1.1 Inll� I�►�i�1'
3
4.
PHONE
327 - 7232-
PARCEL NUMBER /S Ig Ir4— _ al 4-
0.AC, ►.'. 170' Or- 1.h1 10
ADDRESS
19,AL'
CONTRACTOR
ADDRESS
ZIP
Required Set Backs in Feet
North 'South East 'West
PHONE
Size of Parcel
ZIP
Type Const.
Occupancy
Zo a Cl�asssification
l 'IG
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8. A-1261 � (o 141 (� -C *v � IN
VALUATIO Source GAS ELEC IC WATER
of
9. Utilities
Req'd.
Rec'd.
Not Req'd.
SEWER
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
SIGNATURE
DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SPECIAL APPROVALS
REQ'D. REC'D.
Zone Clearance
SEPA Checklist
-;14
SPECIAL C� DITIONS:
1, �� M 33 6 I II a �8 ►
° 1
•
DATE
OFFI
AP'ROV ' OR ISSUANCE
FEES COLLECTED
Single $
1
Building 69.0a
O ' 0a
Plumbing
Mech.
4
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
7 ` 4-74-2-
DATE
02* *1000
* 10.00 N
* 10,006
E *0,00 8
47412
09 -26 -79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09- :26 -79 474.22 *1a00,a172
RECORD OF INSPECTIONS
DATE REMARKS
.0*
Final Inspection
INSPECTED BY
06-59-.X6
E V.11.11
00 C
*J 000R
053 *1000