1979, 09-12 Permit: 79-3826 Special InspectionPLAN 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
t 161b r601-1
2. BLOCK SUBD
IVISION ILJ 1 `t 2L UM Nor
OWNER _ ON
3. �H��E — 33?
ADDRESU 13'(-� P
r-' z�,.� ZIP�f4'f�^
12-5�� WI'rA��,, '�/ PHONE'G
KA ;
4. CADDRESS ZIP
DESIGNER
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South Eas
(West
Size of Parcel Zone Classification
PHONE
ZI P
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in
DWL Area I Basement Area
6.
CHANGE OF USE FROM
TO
Split Entry
Garage Area
Split Level
Sq. F
Storage
Rancher
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
O MECH.
O RPL.
❑ M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. I is(Kr�5I611
VALU aTION Source
of
9. Utilities
I hereby certify that I have read and
on reverse side, and know the same
type of work will be complied with
to give authority to violate or cancel
performance of construction.
9/5/7
DATE
GAS
ELECTRIC
WATER
SEWER
examined this application and have read the "NOTICE" provisions included
to be true and correct. All provisions of laws and ordinances governing this
whether specified herein or not. The granting of a permit does not presume
the provisions of any other state or local law regulating construction or the
.111�,A,
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D.
REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE' 7 / OFFICI
APPROV
66ro1g6 ihi r T'►N6r
'
2..k,
ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
r1_
Cl
TOTAL $
DATE
PERMIT NUMBER
02*
A
38252
09-12-79
2 6479.
*800
*800 N
*8006
*0.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-12-79
582,62 *8,0.02x'