1979, 10-11 Permit: 79-5783 ResidencePLAN 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.
4.
JOB ADDRESS '
C9tik"L / N
LoT
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
/11,05/</
4NER
4`7>4.
PHONE
PARCELNUMBER/S /35 3 -�Fpc'
5 'Fr ,1,4-)-N [v ( 5O Fr o pg D 210
es/z''y�� ar DLI\ z 5— Utak-_
ADDRESS
/v s0/5 P7
CONTRACTOR
ADDRESS
ZIP
Required Set Backs in Feet
North 1 h (South
East ✓ 2 (West
PHONE
ZIP
Size of Parcel Zone Classification
Type Const.
Occupancy
DESIGNER
5. ADDRESS
PHONE
Valu ion_
ZI P
1,l ere,z)0.0
19 e8ment Area
Sprinklered
❑Yes TANo ❑ Req'd.
Building Area in Sq. Ft.
.471
Are Storage
5-2 2
CHANGE OF USE FROM
6.
TO
Split Entry
SpliyLevel
Rancher
TYPE
7. OF
WORK
❑ ALT. 0 AD'N. ❑ RPL.
O PLMB. 0 MECH: ❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
of Req'd.
DESCRIBE WORK
8. /C1 C61--) }/`-'T L%
VALUATION
9. ,S9/ov
Source
of
Utilities
GAS
ELECTRIC
!'vi? -ti
WATER
SEWER
TiQ
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
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
/%
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CO DITION:
NE'c<f
•
DATE r, OFFICIAL t-1- /7.2-f_ 4
APPROVED FOR ISSU'N-bE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 211
PERMIT NUMBER
79 -5"7e
DATE
02* *211,00
*211.00
*211.006'
E *Q00 8
578.22
10-11-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISIBECOMESIAPPERMIT.
578,32 *211.00°'
ok
28:0 0
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FG
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