1979, 09-28 Permit: 79-4911 RemodelLAN 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 P,6`/
S 7
1. kV 1zrl It s�� Tar)
LOT BLOCK SUBDIVISION
/4c)Tr44f1it*C A 7 '
OWNER
t t
3 ppia
PHONE
92G-Yo23
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S 415-4r -0714.
646' -or- N I ad of . ' c tL'7 ,s,p)
/db' OG
ADDRESS
ti /2r l 135/- r -t)
71P
Q�'20h
Required Set Backs in Feet
North
South
East 'West
CONTRACTOR
4 5M
ADDRESS
PHONE
Size of Parcel
/70
Zone Classification
4Get
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes XNo ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
%BOO
ADDRESS
ZI P
DWL Area Basement Area
PiEr
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
TYPE
7. OF
WORK
II NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
O RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
1
Split Level
2- 17,/77
Nofioors
Rancher
No. Rooms
.4
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 4sirifiwatiiimirerjW"
VALUATION Source GAS
f
9. Utilities %Ure-%,.
LECTRIC %
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. e g :nting of a per it doe . presume
to give authority to violate or cancel the provisions of any other sta or lo al law reg •ting o on or the
performance of construction.
3Y
DATE
SIGNATUR
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
�EN ] C2i1' t -e i i # /..) O657
DATE
OFFICI
APPROV
c
OR ISSUANCE
FEES COLLECTED
Single $
Building /2. !, O
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $/2 • 490
DATE
PERMIT NUMBER
29 -- c fc f (
02* *1200
* 1200
* 1 2006
E *Q00
491.02
09-28-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09 —28'—N 49L1Z *120'0°-'