1979, 10-01 Permit: 79-5052 ResidencePLAN NUMBER
2- 2/6
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 ADDEIESS
1.5, 14'0 A I/�SJ /
LOT BLOCK UBDIVISION
2
1 PIS 2 AVt7 4Or1
OW MR
3
46 I ►� 13o-r1G ►v1 1 614
ADDRESS
il-741
CONTRKTOR
4.
M,
ADDRESS
PHO
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S re,t914.41 Op14 5757
ZIP
Required Set Backs in Feet
North � 'South2
East 3�`" 'west g. 0
PHONE
Size of Parcel Zone Classification
'11\4 I4 \I1,
Occu ancy SI*inklered
❑Yes o ❑ Req'd.
ZIP
ype
DESIGNER
PHONE
ADDRESS
ZIP
CHANGE OF USE FROM
6.
TO
TYPE
7. OF
WORK
(W ❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
Valuation Buil1ing Area in Sq. Ft.
DWL Area Baseme t Area Garage Area
Split Entr I Sp t Leve
o. Baths
No. Floors
00ms
Stoo !
ge
ed
Rancher
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WO
•
V UAIION
a X01000
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 r: igulating c tion or the
performanq'e of construction.
lource
of
Utilities
ATV-10o A1 -1 'X -
GAS ELECTRIC WATER
VMit
SEWER
••W
DATE 31
DEPT.
SIGNATURE
SPECIAL APPROVALS
REQ'D.
REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
ne Clearance
`,ecklist
SPECIAL CONDITIONS:
Np UM N114&I PR
rtir 'i a�V 1 �vl _
aid .f KK5
DATE
APPROVED FOR ISSU
CE
FEES COLLECTED
Single $
Building 4- 75- d0
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT r'.jMBER
DATE /D — / -7q
02* *7800
*7800
*78.006
E *Q00
505;18
10.-01-79
2 6479
rz
O
— W
Cr)
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10''•=01 -7' 9
505,25 *78.0OaI--
Lek Co
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