HomeMy WebLinkAbout1979, 09-10 Permit: 79-3696 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
1.
JOB ADDRESS
2.
3.
LOT
BLOCK
rJ. (41 4COC -1+IS
SUBDIVI ION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
PHONE
PARCEL NUMBER /S
ADDRESS
ZIP
Required Set Backs in Feet
North 'South
'East
4.
5.
CONTRACTOR
ADDRESS
ADDRESS
6.
Qwt., leak drk9i,
R4. 6ro kx.0 e
TO
CHANGE OF USE FROM
PHONA
¥5 q//
Size of Parcel
(West
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
t5Y 7t
Valuation
ZIP
DWL Area I Basement Area
Building Area in Sq. Ft.
Garage Area I Storage
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
KNEW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
)- t-�e -}-mss
DESCRIBE WORK
8.
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
9.
VALUATION
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
type of work will be complied with whether specified herein or not. The
to give authority to violate or cancel the provisions of any other state or I
performance � of rcons�� n.
DATE /7
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
REC'D.
Zone Clearance
SEPA Checklist
ws and ordinances governing this
oes npJ�t presume
struLftion or the
SPECIAL C• i TIONS:
DATECJ / -7/ OFFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
DATE q — /C) — 79
04* *48,00
*48.00
*48.006
E *0,00
369,58
09 -10 -79
R 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09- 10i -79
569.62 *48,002R'
DATE REMARKS
RECORD OF INSPECTIONS
* rf 9' r
Final Inspection
INSPECTED BY
00-J 0-.16
2C62%
E 4;00: '2
*1200R
4CrE00
*Cti$00