1979, 09-24 Permit: 79-4626 Plumbing 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
O BLOCK
41
LEGAL DESCRIPTION — SEE ATTACHED
UBDIVISION
PARCEL NUMBER /S
3. OWNER^ S
ADDRESS
/oba 7-1L
ONE
ZIP
Required Set Backs in Feet
North
South (East
West
C 7 ONNTRACTO !
4. / '- - E ,%e YiSee
ADDRESS
DESIGNER
PHONE
Size of Parcel
Zone Classification
2o6'
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
gNEW ❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ BLD. PLMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
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 sigsie, 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 • • - 1 e
to give authgrity to violate or cancel the provisions of any other state or local I. reg sating con
performance ,f construction.
DATE
SIGNATUR
DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SPECIAL APPROVALS
REQ'D. RECD.
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
7:I-OFF]
APPROVED 1' ISSUANCE
FEES COLLECTED
Single $
Building /`j
Plumbing 6-.2-5 '00
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify) 3fi 00
TOTAL $, e1 to
DATE
03* *2500
*2500 cp
*2x006
E *Q00 8
4625B
09 -24 -79
2 6479.
® 0
r
WHEN MACHINE VALIDATED IN THIS SPACE,
THISdICOIKIEt A,REi5iMIT.
4.6 2.6 z * , I-
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY °
E
C'? a
+,OOC
4500;.
4S2UU 12
+52'00