1979, 11-26 Permit: 79-8307 ToiletPLR.N NUM'rIER
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.
LOT
2.
BLOCK
��1,3 •
S BDIV S ON
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
t�•
ADBRESS
I� 1
PH(Pat
PARCEL NUMBER/S
///k3
CONTRA OR
4. ADDR
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TO
PH NE
Z9)
PHONE
ZIP
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
*PLMB. ❑ MECH. ❑ M.H. ❑ POOL
0 OTHER
Required Set Backs in Feet
North South East 'West
Size of Parcel
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
DWL Area
Split Entry
No. Baths
Building Area in Sq. Ft.
Basement Area I Garage Area Storage
Split Level Rancher
No. Floors
CERTIFICATE
of EXEMPTION
No. Rooms
Rec. Room
Req'd. Rec'd. Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Cid
So
0
Utilities
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 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 not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE /f/2.4 7OFFICIAL
(( APPROVED FOR ISSUANCE
FEES COLLECTED
DATE
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
7 3o7
03* *550
*550 N
p *5506
B *000 0
83068
11-26-79
$ 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11"26 79 8'30,75 X5.50-2