1979, 07-26 Permit: 79-1063 ACPLAN 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 ADIDRESS
LOT
BLOCK
3.
OWNER
R a
SUBDIVISION
6q2 C Mr) c
ADDRESS f
Yl '1 ll.� q I GL'(
PHONE
3 5-
4.
CONTRACTOR II
ADDRESS
DESIGNER
C33 e)9
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
DESCRIBE WORK
tTN1
PHONE
ZIP
PHONE
ZI P
TO
AD'N. ❑ RPL. ❑ MVE.
W\MECH: ❑ M.H. ❑ POOL
cor 004j 3101,,2
❑ OTHER
VALUATION
9.
Source
of
Utilities
GAS
Required Set Backs in Feet
North
South East
Size of Parcel
Type Const.
Valuation
DWL Area
Split Entry
No. Baths
West
Zone Classification
Sprinklered
Oyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors No. Rooms
CERTIFICATE
of EXEMPTION
Storage
Rancher
Rec. Room
Not Req'd.
Req'd.
ELECTRIC
xX
WATER
SEWER
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse s ide, 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. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Check list
SPECIAL CONDITIONS:
DATE 7 -.20- %/ OFFICIALP 47 x" '4�"e""`-'`
APPROVED FOR ISSUANCE
Rec'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. (
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ L' 6
PERMIT NUMBER
79-1063
DATE % • - ) 7
04* *7.00
*7.00
*7.006
B *0,00
1 062
07 -26 -79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07 -2 6 -79
106,32 *7,00°1
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
N. oc
s a c
04* *so°