1979, 09-14 Permit: 79-4048 Plumbing Fixtures'PLAN 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
1.
2.
JOB ADDRESS
LO S,BLO 1BDIVISION o Uj( C:S
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
3. Ae y-- Il
ADDRESS
CONT
4. A7'T:RACT9�
E pi/(yes ivS
-7 rke/Arl-
DESIGNER
5.
6.
`F;- 74b7
ZIP
PARCEL NUMBER/S
P NE
---)4z
Required Set Backs in Feet
North South (East 'West
Size of Parcel 1 Zone Classification
z
9.? 6
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
CHANGE OF USE FROM
ZIP
TO
DWL Area I Basement Area r Garage Area
Split Entry
Split Level
Storage
Rancher
TYPE
7. OF
WORK
8.
ANEW
0 BLD.
DESCRIBE WORK
VALUATION
❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
UrPLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
/9.1-, 4/r,6- /1(
GAS
Source
of
Utilities
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ELECTRIC
WATER
SEWER
9.
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 n• •resume
to give authority to violate or cancel the provisions of any other state or local I. regu .ting struction •r the
performance of construction.
DATE
DEPT.
7'
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
„27,540
Other (Specify) 2 V
peyut t` 11 -
TOTAL TOTAL
DATE 6
PERMIT NUMBER
7 -,-/e.41-0
z/Z,
03* *3050
*3050 to -
*30,506
E *0.00
404.78
09-14-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-14-79
40485
*50,50 °1-
INCPPPTnD