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1979, 10-01 Permit: 79-5095 PipingSize of Parcel rLAN 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. / 3'5 LOT BLOCK SUBDIVISION 2. / LEGAL DESCRIPTION — SEE ATTACHED PARCEL NUMBER/S /4; / / 4norrs 41/VP-) it -p) OWNER ADDRESS PHONE y';9- 32.6) 7/ 4. ADDRESS CONTRACTOR DESIGNER ZIP 9Pz1 � PHONE ZIP 5' ADDRESS 6. CHANGE OF USE FROM TYPE 7, OF WORK PHONE ZIP TO ❑ NEW 0 ALT. ❑ AD'N. 0 RPL. 0 MVE. ❑ BLD. 0 PLMB. MECH: 0 M.H. 0 POOL DESCRIBE WORK 8. /.,4 y pi/ VALUATION 9. Source of Utilities GAS ELECTRIC Required Set Backs in Feet North 'South 'East Type Const. Occupancy West Zone Classification Sprinklered ❑Yes YiNo ❑ Req'd. Valuation _ P 2.5Z). «� DWL Area Basement Area Split Entry No. Baths Building Area in Sq. Ft. Garage Area CERTIFICATE of EXEMPTION WATER Storage Rancher No. Rooms 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 per it does not presume to give authority to violate or cancel the provisions of any other st. •r local law regu .tin• construction or the performance of construction. DATE 0 9 SIGNATUR DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPCONDITIONS: DATE 10 _P OFFICI Rec. Room FEES COLLECTED Single $ Building Plumbing Mech. /2. G3° Plan Check SEPA Mobile Home Other (Specify) TOTAL $4? ©C) hi DATE PERMIT NUMBER 04* *1200 *1200 N 509.4e 10-01-79 e 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 10'01-79 509.55 * 12 0;.0'; a PI APPRO/ OR ISSUANCE —