1979, 11-19 Permit: 79-8090 FixturesPLAN 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
LO
BLOCK
SUBDIVISION
OWN ? R
/
3 ' M e. 6-14
ADDRESS
4. ADDR
CONTRA ORS
ABEIEW44141=111-
111111•11111411=11111
6.
LEGAL DESCRIPTION - SEE ATTACHED
PHO "E
DESIGNE
CHANGE OF USE FRO
PHONE
z lam' 6
PHONE
PARCEL NUMBER /S
Required Set Backs in Feet
North 'South
East
West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Valuation
ZIP
DWL Area Basement Area Garage Area
TO
Split Entry
Split Level
TYPE
7. OF
WORK
❑ NE
LD
DESCRIBE \W ¢\R
8.
VALUATI0
9.
'ALT. gAD'N.
B. ❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Storage
Rancher
Rec. Room
Not Req'd.
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
',i - ,Cr)e
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 ordinan ec_gavatrning this
e
type of work will be complied with whether specified herein or not. The granting of a pe
to give authority to violate or cancel the provisions of any other state or loc law r la
performance .f construction. (�
DATE r SIQNATURE�`
t does
Ing constr
n
or the
DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SPECIAL APPROVALS
REQ'D. REC'D.
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
a
FEES COLLECTED
Single $
Building
Plumbing La-`5C
Mech.
Plan Check
SEPA
Mobile Home
O her (Specify) 3 '06)
TOTAL $13, S U
DATE
PERMIT NUMBER
7q -gogq
dA ill 7
03* *15,50
* 1550
* 15.506
E *000
808.92
11 -19 -79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
/ /—i / ���1 �pj //"� THIS BECOMES A PERMIT.
DATE —� OFFICIAL'�r��LQ,�� lL.4 '11 9" -7,9 8 0 9.O Z *,l 5.5 O °a'�
APPROVED FOR ISSUANCE —
r
RECORD OF INSPECTIONS
Final Inspection
DATE REMARKS INSPECTED BY
. 1 . 1 - J � — �
1 L. 0