1979, 09-17 Permit: 79-4096 Plumbing FixturesAPPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPL .:ANT: COIV
ETE NV
ERED SPACES — PRESS F RD TO MAKE 4 COPIES
JOB
LOT
2.
7/0
BLOCK
SUBDI
3. PD1fRavh-
ADDRESS
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
CONSSRCTOR
4.`%446
DR SS.
DESIGNER
5. ADDRESS
ZI P
PHONE
Required Set Backs in Feet
North 'South
Size of Parcel
East
West
Zone Classification
6.
CHANGE OF USE FROM
7.
9.
TYPE
OF
WORK
ITO
W ❑ ALT. ❑ AD'N. ❑ RPL.
41"" D. LMB. ❑ MECH: ❑ M.H.
DESC BE W
LU I
Source
of
Utilities
T =�
GAS
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation
❑ MVE.
❑ POOL
❑ OTHER
Building Area in Sq. Ft.
DWL trea
Split Entry
No. Baths
Basement Area
Garage Area
Storage
Split Level
Rancher
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ELECTRIC
WATER
SEWER
I hereby certify that 1 have reap. anu .,.ami. ed :..is application and have read the "NOTICE" provisions included
on reverse side, and know the same to be tree and correct. Al provisions of laws and ordinances governing this
type of work will be complied with whether specified he : ^,n o ot. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other g'tate or local I w r••ulating construction or the
performance of construction.
A fwp
DATE
SIGNATURE
DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SPECIAL APPROVALS
REQ'D.
REC'D.
SPECIAL CONDITIONS:
Zone Clearance
SEPA Checklist
OFFICI
APPR
.D-40R ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
P
PERMIT NUMBER
-7 -1-°
03* *43.00
* 43.00 16
* 43.006
A *0.00
409.52
09 -17 -79
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS COM B A IT.
0 ,�;,� PE M .�7,� 4'09.62 *43,OQ
DATE REMARKS
RECORD OF INSPECTIONS
e
Final Inspection
INSPECTED BY
ccrAe
STCovl
H . *QOL
*E12OOx