1979, 10-15 Permit: 79-6009 Plumbing FixturesLAN 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
LOT
BLOCK
.449(9s Puc-ke- e
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIVISION
2.
OW R
3. '4' ff? AA—Yra. v c
AD RESS ;
'7.32-2. Di J1,5L 041
PARCEL NUMBER/S
PHONE
ZIP
CONTRACTOR
4. �le2— I VWet. Lt AAO
AD RESS
l�l 13 LZ /45c,
PHONE
Required Set Backs in Feet
North (South !East (West
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
DESIGNER
5.
ADDRESS
PHONE
Valuation
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.
❑ PLMB.
El MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths No. Floors
CERTIFICATE Req'd.
of EXEMPTION
No. Rooms
Rec. Room
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
I hereby
G
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 +f 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.`{q or I.cal law regulati construction or the
performance of cnstru. ion.
DATE // <t ‘7‘f SIGNATURE
DEPT.
S'ECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL COND TIONS:
DATE/ —�%FFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
uci
18 '--
PERMIT NUMBER
DATE
03* *18.00
* 1800
* 18006
E *000
600,8210-15-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 15-7'9
600.92