1979, 08-14 Permit: 79-2114 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
1' '-9 Gam.
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
3. OWNB-- ; /e4T aADDRESS
PHONE
ZIP
Required Set Backs in Feet
North
South
4.
CONTRACTOR
4j
ADDRESS
17. ,65-/3 2
DESIGNER
PHONE
Size of Parcel
East (West
Zone Classification
ZIP
PHONE
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ADDRESS
ZI P
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Ranche
TYPE
7. OF
WORK
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.
9.
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 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 regulating construction or the
performance of construction.
DATE
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
i
DATE I `"'7OFFICIA C.:..,----
' �,
APPRO FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing A.1- S-0
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
,3 OD
TOTAL $ 30' -S1)
DATE
PERMIT NUMBER
03*
A
211,3
08 -14 -79
6479.
*30.50
*30.50
*30.506
*0.00 8
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Did-14-79 211.4
*30,50
Day
CC
U
w
Ca)
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
AcS
053-1 it—Ad
511'21
V *,,00
*2020R
*2020 P2
*2020