1979, 09-10 Permit: 79-3689 ResidencePLAN NUMBER
4-11 no,i Ro-ct_02)
• -
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT C91
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
3.
oWt7tHHA H,kr �iN7 l
ADQR SS
� s o.
PHONE
787
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
5-3 7
(Al Rol F ) \/6e1
Requi Set Backs in Feet
North 'South .T LEast 76 'West
4.
CONTRACTOR
K11
ADORES
's j — 7
DESIGNER
5' ADDRESS
'7 e f '4
PHONE
ZIP
Size of Parcel
--aI7 x 372 -
Type Const.
Occupancy
Zone Classification
1z1G
Sprinklered
❑Yes ivo ❑ Req'd
PHONE
Val tion
ZI P
�OJJ (.TC)o 0
DWL Are`d
asps
Building Area in Sq. Ft.
:Z. 2 f�7
rea
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry 1 Split
Level
Rancher
TYPE
7. OF
WORK
�L�,/NEW ❑ ALT.
kG BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
0 M.H.
❑ MVE.
O POOL
❑ OTHER
No. Baths
No. Flogrs
No. Rooms
Rec. Room
Li/1)r- .
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd-
Not ReA'd.
DESCRI
WORK
ALUATION So4lce GAS ELECTRIC WATER SEWER
9. (9 161° UtilitiesV I.
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 I. al law regulating cons uction or the
performance of construction.
DATE 4(-- "J— 7 C7' SIGNATURE
DEPT.
'SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
P/7 ,
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
49 02 vr-
(c 06T jt c4ALA .., 00, 79 role f GnN
DATE
y�r
OFFICI
i -t
APPROVED FOR IS EANCE
FEES COLLECTED
Single $
D
Building /Q✓ 1r
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
77 - 7.7)(,)639
02* *10050
* 100.50
* 100.506
A *0.00
368.8
09-10-79
2 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COMES A PERMIT.
09-110-79 368,95' *1'00,50U