1979, 10-08 Permit: 79-5495 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.
LOT
2.
S, Q7 "/Lhs7
SUBD VISION ISION
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWN R
3. d49/
ADDRESS
�-4vre 4A�
CONTRACTOR
4. w J7
DESIGNER
5 ADDRESS
PHONE
ZIP
Required Set Backs In Feet
North 'South [East
'West
PHONE
535-- Y.- 7,.7-7
Size of Parcel
Zone Classification
y_7-7 c lir
ZIP
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
ANEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
5 A - y/Ai
VALUATION
9.
Source
of
Utilities
1T GAS
ELECTRIC
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 /L9 _ - - T7 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE IU 4 OF
APP':"' FOR ISSUANCE
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $711 6)
PERMIT NUMBER
DATE
03* *38.00
* 3800
* 3[1006
E *0.00 0
549.42
10-08-79
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 —0 —7.9
549.55 *38,0021-2