1979, 12-31 Permit: 79-9670 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3.
JOB ADDRESS
//
LOT
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
BLOCK
: C t�
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER.- )
ADDRESS_
72C bk4tvfew�atLt/47
CONTR CTOR
4. ��/h9
ADDRESS //
/�1c"C. S ICA/
DESIGNER
5.
ADDRESS
6.
PHONE
C; `1c7F
ZIP
PARCEL NUMBER/S
PHONE
/71Z1-6 35/
ZIP
Required Set Backs in Feet
North 'South (East (West
Size of Parcel
Zone Classification
Type Const.
Occupancy
PHONE
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
CHANGE OF USE FROM
ZIP
TO
DWL Area I Basement Area
Split Entry
1 Garage Area
Split Level
Storage
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
DESCRIB RK
8. (1,.0 I CZ
VALUATION
9.
❑ AD'N.
O MECH;
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
Su'rce
of
Utilities
GAS
❑ OTHER
ELECTRIC
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
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
CpFFICIAL GY7f- (:til,t'In�f71 ,
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing�—
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
-lq-9l0?o
DATE A.-2
03*
*38.00
*38.00 IT
*38.006
E *000 g
966.98
12-31-79
2 6479.
U
— W
0.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS1BECO�VIES APF MIT.
967.0V *38,O0U