1979, 11-14 Permit: 79-7821 Fire Damage RepairPLAN NUMBER
i
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
JO ADDRESS
I�y
1. oS CST'
LOT . 3
BLOCK SUBDIISION
2. 3 2 -
LEGAL DESCRIPTION — SEE ATTACHED
CoBcer 1-0u7L5 SupIArBSTtN
O NER
3 IAogtRoss
ADDRESS
N `i los (�T
CONTRACTOR
4. M S£etrcc
ADDRESS lo. MAPA
DESIGNER
6' ADDRESS
PHONE
12122-2115 •
PARCEL NUMBER/S
o25�IZ' S'1°3
ZIP
ii°1 z ice
Required Set Backs in Feet
North 'South
East 'West
PHONE
535-8$Cl
'61
i 2-02
Size of Parcel Zone Classification
154 x (1 D APP.
Type Const. r Occupancy
elery
F.E I
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
2500 --
Building Area in Sq. Ft.
ZIP
OWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
zr ALT.
0 PLMB
❑ AD N. ❑ RPL. 0 MVE.
❑ MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd..
Recd.
Not Req'd.
DESCRIBE WORK
8. PEPATR RTc6 DAMMC LMWNoa EC: Damol.66C
♦1 VALUATION SourceuAS ELECTRIC W TER
g, 2 -SOL? 00
Utilities .
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 %/ �/ I SIGNATUR
DEPT.
SPECIAL APPROVALS
REC'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL _• NDITI a S:
00 TI -143S pEQ. -1305 1tIoP -
tVs6P- To SvTAP.T 0Fcoot twpr-
DATEa .1q. L OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building 3010
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
"19 -1821
02* *3800
*3800 >n
*3800'
B *Q00
78202
11-14-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11'7i14 -7t9'
•
78212 *38,00ptri-
DATE REMARKS
RECORD
OF INSPECTIONS
. • ;
Final Inspection
INSPECTED BY
J J -1 Cr -ad
* 28 CC:
• 2200 N
DS* • 2E100
•