1979, 10-12 Permit: 79-5863 Residence Renewal of N0806e
PLAN 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
1.
2.
3.
JOB AD
R E/SS
.z /4 L42 -
LEGAL DESCRIPTION — SEE ATTACHED
LOT
4
OWNER
BLOCK
.`3
SUBDIVISION
u
ADDRES A
of
4.
CONTR TOR
ADORE
//C I,
P/ONE
ZIP
rrQQ
PHONE Z
ZIP
PARCEL NUMBER/S 2-3513 -
.�°ci
-
Required Set Backs in Feet
North 'South
East
'West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
G1Sprin ere,fed
tl
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Arealir
Storage
a
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
DESCRI E WORK
8. . ( /
•
VALUATION
D ALT.
O PLMB.
9.
❑ AD'N.
❑ MECH:
/1.1.44-
Source
L. -tSource
of
Utilities
❑ RPL.
❑ M.H.
AS
❑ MVE.
O POOL
OTHER
ELECTRIC
No. Baths
a/
No. FI ors
No. Rooms
S
Rec. Room
WATER
CERTIFICATE
of EXEMPTION
SEWER
Req'd.
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 he 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
performanceof construction./�
DATE /0 -!/ 2 7_ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITI • S:
DATIZ/4) —/2-7IFFICIAL�/C/CZi I �l�Lti'f?/✓�
APPROVED FOR ISSUANCE
Rec'd.
Not Req'd.
X
FEES COLLECTED
Single $
Building
3/ O'O
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
KJ
PERMIT NUMBER
DATE /4 —/Z — 76?
02* *31.00
* 31,00
* 31.006
B *0.00
5862
10-12-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESPERMIT.
10
—9.2r -7,9
.I / I 5.863
8L3 a *LOQ a F
T'
RECORD OF INSPECTIONS
REMARKS
Final Inspection
INSPECTED BY
Y gala'
10—Js-1d
28(15 i
8 ►000 2
*21'008
•21'04 av
0 . •21'00