1979, 11-28 Permit: 79-8462 BedroomPLAN 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
3.
JOB ADDRESS
colt-)
L BACK SUII VI 1-4(V L,6 A -1 0H
OWNER,
4 Mcdit 5
4.
D ,Eri-71e ` r3AH
I�l
CONTRACTOR
Mrrj
ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
PHO EI
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S DI C/90
Required Set Backs in Feet
North
South East
West
ZIP
PHONE
ZIP
TO
El NEW Lr'J ALT. El AD'N. ❑ RPL. ❑ MVE.
LLS BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
8 V [ LATION Source GAS (A�C MELECTRIC
9.500 � of
Utilities
Size of Parcel
i o'c I40
Type Const.
Valuation
DWL Area
Zone Classification
Sprinkll
Occupancy
Basement Area
Split Entry
No. Baths
ered117r
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
Storage
Rancher
No. Rooms
Req'd.
Rec. Room
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 /o violate or cancel the provisions of any other state or loc.r law regulating construction or the
performance of const uction.
DATE
DEPT.
SPECIAL APPROVALS
REQ'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
SIGNATURE
REC'D.
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
H kL p r rofki
D FOR ISSUANCE
FEES COLLECTED
Single $
Building II 10, 00
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
DATE
02* * 1 Q0-0
*1000 N
*1 000
E *000 8
84612
11-28-79
.3 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B 9OM A
lI2 d -79MIT.
346.255 *,10.002r2