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1979, 08-29 Permit: 79-3040 Plumbing Fixtures
PLAN 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. 2. 3. JOB ADDRESS i'/ o5- /M /k,' LOT BLOCK SUBDIVISION LEGAL DESCRIPTION - SEE ATTACHED OWNER PHONE PARCEL NUMBER /S ADDRESS ZIP Required Set Backs in Feet North 'South East 'West 4. CONTRACTOR 7-7- go ni NO r PHONE gay --97/9 Size of Parcel 1 Zone Classification ADDR; /33 5. ADDRESS Dr. PD, ©,k /yogi/ 5pe kale TO CHANGE OF USE FROM 6. TYPE 7. OF WORK Type Const. Occupancy Sprinklered ❑Yes ❑No ❑ Req'd. PHQUE ZIP Valuation (Building Area in Sq. Ft. DWL Area I Basement Area Garage Area Storage Split Entry Split Level Rancher ytsL NEW ❑ BLD. ❑ ALT. ❑ PLMB. ❑ AD'N. ❑ MECH: ❑ RPL. ❑ M.H. ❑ MVE. ❑ POOL ❑ OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE of EXEMPTION Req'd. Rec'd. Not Req'd. DESCRIBE WORK 8. / a C. I � �C /1-1A- VALUATION 9. Source of Utilities GAS ELECTRIC WATER SEWER I hereby certify that 1 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 opsl law regulating construction or the performance of construction. I L O DATE SPECIAL APPROVALS DEPT. REQ'D. SIGNATURE REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL DATE ;,9 9 OFFIC APPR: i FOR ISSUANCE FEES COLLECTED Single $ Building T� �y� Plumbing �° L'V Mech. Plan Check SEPA Mobile Home Other (Specify) TOTAL $ p PERMIT NUMBER 79 - 3c4O DATE 03* A 303.92 08 -29 -79 2 6479, * 33.00 *3300 * 33.006 *0.00 WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 08 -29 -79 30402 *33.00°i RECORD OF INSPECTIONS Final Inspection REMARKS INSPECTED BY cr .X6 9—SO—,16 20761 M +G0' *2200 02* *2200