1979, 11-06 Permit: 79-7372 ResidencePLAN NUMBER ? 2 3—
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.
4.
JOB A ;1 `1 11 &J-
SUB'IJIVISION
Mr2f1 22N,0 Avg- T
OWN
ADDRESS 1 x ✓61 l�pAl✓
c°NN/—;R T
LOT
BLOCK
ZIP
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S p� PN pig/ 071554103
Required Set Backs in Feet
North 3 0 !South
East 1`a West 1
Size of Parcel
ADD,. °_SS
ZIP
y�. �z x fq -g•9�
Type Const.
Zone Cl ssification
I 4FL
ri,
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DE SIGNER
J. t`PDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Basement r Garage Area
14(4 t4 )
Ce I r/F
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
El/NEW ❑ ALT.
iBLD. ❑ 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.
8.
VA ILLU'r,I,,AAVTII I O N / GA,
9. -a f 7e7U
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 grantin of a permit does not presume
to give authority to violate or cancel the provisions of any other st . or local :vv regul tinngg constructi or the
performance of construction.
Source
of
Utilities
ELECTRIC
WATER
CCij Q[/r
SEWER
tip J'C./
DAT
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATUR
SPE I L CONDITIONS:
Env. Health
«019
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
121-104-S
a►c
DATE 11'2.' OFFICIAL _) r�rRiJU ZLA.`V
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
367,00
TOTAL $ 30-7%
DATE
�,. PERMIT NUMBER
71— 737 2
11 -& -77
02* *30700
*307.00 In
*307.006
B *000
737.12
11 -06 -79
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BOME b� —7 A P MIT.
1EC1 —C
737.25 *,307,00°1
DATE REMARKS
ti.
RECORD OF INSPECTIONS
1
Final Inspection
INSPECTED BY
2,11
*Goo 8
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