1979, 09-11 Permit: P79-3786 Plumbing FixturePLAN 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.
3.
JOB ADDRESSt 3904' f3,S
LEGAL DESCRIPTION - SEE ATTACHED
LOT
0
BLOCK
SUBDIVISION
LLI•e t40nitcr.,L�
ADDRESS C'
PHONE
9291084/
ZI P
e_o 4
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South
East
'West
4.
5.
CONTRACTOR
SG.w a -
PHONE
SocePI
Size of Parcel 1 Zone Classification
ADDRESS
DESIGNER
ADDRESS
ZIP
S.yry
Type Const.
Occupancy
Sprinklered
Dyes DNo 0 Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
❑ BLD.
❑ ALT. 0 AD N. 0 RPL. ❑ MVE.
*PLMB. 0 MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
O
8. 1Z U; tro 1U Or 016;,v�
Source
of
9. Utilities
VALUATION
F1 xt-
GAS
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 correc . 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 othl law regulate . constructlo •r the
performance of construction.s
nns
DATE / /D - /, SIGNA
DEPT.
SRECIAL APPROVALS
/. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
11
C Q,
0 FOR ISSUANCE
OFFIC
FEES COLLECTED
Single $
Building
Plumbing t -5:
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
"7g - 22,e,
DATE
03* *550
*550 Lz
37852
09-111-79
3 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISllR§C!-1 Ory1 S1—Af MIT.
3.18. 6 z * 5•,0 a