1979, 08-28 Permit: 79-2945 AdditionPLAN 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.
JOB ADDRESS
/ ;Z
LOT BLOCK
2. /
ER �JJ
3.4AD:-//
Rc �J.L•L L¢
1/ / �? / � 4 t -✓, '.6-
CONTRACTOR
ADRREss
DESIGNER
C 1_- G G t/G °`- iC i1.i-t 2'•e_
SUBDIVISION
/Z'k-71a - S. k - ,,4,' A...:6--' -
5. ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
PHONE
q:46'1
ZIP
9`1,Zi&
PHONE
PARCEL NUMBER/S
eC07/ /341(l c/4 --RATA
Required Set Backs in Feet
North / / South
Size of ,Parcel
9L1,1(
,//. / //
(East 41 IWest
ZIP
PHONE
Type Const.
Occupancy
Zone Classifica`/tion
(X4 fg4a lii.-i 4r
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area irp Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
AD'N.
❑ MECH:
D RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. jFloors
CERTIFICATE
of EXEMPTION
No. Rooms
d
Req'd.
Rec. Room
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9. ��'i JJ
I hereby certify that I have
Source
0 •
f
Utilities
GAS
ELECTRIC
WATER
SEWER
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 '.r 1.C.— 7'7 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
I''
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
a
DATES /4(OFFICIA114-
14)
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
/mss PERMIT NUMBER
-7 ? q 15
DATE F-.-2O-JT
02* *19.00
*19.00
294.4A
08-28-79
f 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-2'8-79
29452 *1'9,002.172
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