1979, 07-25 Permit: 79-972 ACPLAN 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 ADDRESS
1115
LEGAL DESCRIPTION — SEE ATTACHED
LOT 1 BLOC
SUB !VISION
OWNER
ADDR SS
ACTOR
tr�� C, t, Ur) Lb
et_
4' AgDRES '''j
£ �Jh�''
DESIGNER
5. 601
ADDRESS , ^l/
CHANGE OF USE FROM 1Y' (/
�✓i
ZZg037
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South lEast 'West
PH NE
1"- _iC'71
Size of Parcel I Zone Classification
get
PHONE
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
6.
TYPE
7. OF
WORK
ZIP
DWL Area I Basement Area Garage Area
Storage
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
;16.AD'N.
MECH:
O RPL.
❑ M.H.
DESCRIBE WORK
8.-()f - akin
VALUATION (.1 Source GAS
of
9. Utilities
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
ELECTRI
C 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 cpnstruction.
DATE 4
SIGNATURE
DEPT,
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
•
DATE OFFICIAL
APPROVED FOR ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
CV
DATE
PERMIT NUMBER
79/7,-
O4* *7.00
*7,00 5
*7.00
A *Q00 8
97.11
07-25-79
61479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-25-79
9225 *7,000F