1979, 08-07 Permit: 79-1628 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. 15-'0 G2 �� C t
LOT BL CK SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
OW ER
3. - e . ee" -X.
A DRESS_
/ apo' TA:
CONTRACTOR
4' ADDR SS
PHONE
sa
Z 9.1))
PARCEL NUMBER/S
Required Set Backs in Feet
North (South
(East
(West
PHONE
7
Size of Parcel
Zone Classification
DESIGNER
5. ADDRESS
ZIP
7-0 174
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area
Basement Area n Garage Area Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. ❑ AD'N.
U
'LMB. ❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE�IWORK
8. 2"/(4Mb/ r
VALUATION
9.
ih
Source
of
Utilities
AS
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 pf construction.
DATE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/1
DATE/3
(
130 30
OFFICI
APPROVER ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing 30850
Mech,
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $.5()
DATE
PERMIT NUMBER
-- 16;2-e
03* *30.50
*30.50 175
*30,506
A *0.00
16278
08-07-79
g 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOM A EERMIT.
8 9 162,82 *30.50°H
IFIcnrrT(10