1979, 11-19 Permit: 79-8129 Enclose PatioPLAN NUMBER
—z84
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
3
JOB ADDRESS
OT 2 BLOCK
AQDRESS
SUB elS/�:Ny �, .,w I,,//5
(�/ (J� PJjONE
y— r ( 7-2t5E) 'y -5yo:;
4.
CONTRACTOR
ADDRESS
DESIGNER
5. ADDRESS
PHONE
ZI P
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ ALT.
BLD. ❑ PLMB.
PHONE
ZIP
TO
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S C- 5 3 2 _ 0 g y
Required Set Backs in Feet /
/Z....)North �, !South I= East J !West
DESCRIBE WORK
• ry c/O S .e -
VALUATION
AboV-e Un
Source
of
Utilities
GAS
Size of Par el
Ivy X
Type Const.
Occupancy
Valuation
DWI_ Area
/• r1
Basement Area
Split Entry
No. Baths
Z.neClassifitiol
g1,6I3d 3
Sprinklered
❑Yes ❑No ❑ Req'd.
Buildi Ar,a in Sq. Ft.
Garage Area
Split Level
No. Floors
1
CERTIFICATE
of EXEMPTION
vA rr9rt
ELECTRIC i WATER
to72
Rancher
No. Rooms
2—
Req'd.
SEWER
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 011—: • 7
DEPT.
SPECIAL APPROVALS
REQ'D_ REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONbITIONS:
DATE
OFFICIAL
APPROVED FOR ISSUANCE
Rec. (Room
Rec'd. Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
.C:;
PERMIT NUMBER
DATE
02* *74.00
*7(00
*74.006
E *000
431,41
09-20-79
6,479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'1-19 -7 9 81 a9;Z`
*7400°'
Avoi -now oVb
61AKA