1979, 10-12 Permit: 79-5906 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
PERI NUMB
/9
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS-HARD TO MAKE 4 COPIES
03* * 5 Q:5 0
*5Q50 t6
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
1
* 5 Q•5 0
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
2
B *0.00
69 Q'5
O�'�'ER c t,
PLiONE
Qkxld
3. Jr CJ�C.�f�. K
n3gz
1 0 1 _ 9
ADDRESS
71
ZIP�yi'
Required Set Backs in Feett5�
,
`
North South East West
. 647-9.
.CONTRACTORPHONE
C�
i
Size of Parcel
Zone Classification
JZ A
.�
4' ADDREEEFF$$$SS
ZIP
Type Const.
Occupancy
I
Sprinklered
., s
IY�;W�l
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
5' ADDRES
ZIP
OWL Area
Basement Area
Garage Area
Storage
I
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
J
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE IU NEW El ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
CERTIFICATE -
Req'd.
Recd.
Not Req'd.
❑ -BLD. ❑ PLNIB. ❑ MECH: ❑ M.H. ❑ POOL -
WORK
of EXEMPTION
DESCRIBE WORK
/ /�','� � FEES COLLECTED
$
VALUATION
Source
G/AS ELECTRIC
WATER
SEWER
of
..
9',
utilities
Single $
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 Building
type of work will be complied with whether specified herein or not. ThL of a permit does not presume
to give authority to violate or cancel the'provisions of'any other state oregulating construction or the
Plumbing
performance of construction.
DATE �® lT� G SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL C ITIONS:
DEPT. . REQ'D. RECD. Plan Check
Env. Health
SEPA
O
Planning
_ UW
Mobile Home
CL
C/)
Fire Marshall
Z
Co. Engineer Other (Specify)-
Specify)Utilities-
Utilities
TOTAL $
TOTAL
Zone Clearance
r WHEN MACHINE VALIDATED
IN THIS SPACE,
THISj BECOMES A PERMIT.
SEPA Checklist
9•
5!-9 0..6 z, *��5 0,�15�,0 a'-'
DATE FF
APPR FOR ISSUANCE
_