1979, 10-30 Permit: 79-6984 Plumbing FixturesR�ANj BER
APPLICATiON/PERMIT
SPOKANE COUNTY.-. BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
fir' APPLICANT:. COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
07� "9,3LEGAL
of
DESCRIPTION —SEE ATTACHED
LOT
BLOCK
PARCEL NUMBER/S
2
ISUBDIVISION
OWNER
I hereby certify that I have read and. examined this application and have read the "NOTICE" provisions included
PHONE
3
Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
ADDRESS
ZIP
Required Set Backs in Feet
DATE SIGNATURE
Mech.
SPECIAL APPROVALS
North - South East West
CO TOR
DEPT. REQ'D. RECD.
PHONE
Size of Parcel
Zone Classification
;11- y�
SEPA
4' A ESS
ZIP
Type Const.
Occupancy
Sprinklered
1"7�/ 3
El ❑No 1:1 Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
TOTAL $�
Zone Clearance
.
5. ADDRESS
J
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM7TO
Split Entry
Split Level
Rancher
6.''7
-
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE ❑ NEW' ElALT. ElAD'N.
ElRPL. ElMVE.
7, OF
E3BLD. PLMB. ElMECHi
❑OTHER
ElM.H. ElPOOL
CERTIFICATE
Req'd.
- Rec'd.
Not Re,
WORK
of EXEMPTION
DESCRIBE WORK
FEES COLLECTED
8
VALUA I IUN
Source
VvK
of
Utilities9,
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. 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.
Plumbing
DATE SIGNATURE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
TOTAL $�
Zone Clearance
.
WHEN MACHINE VALIDA'
SEPA Checklist
c
THIS BECOMES A PERMIT
1;0 ,7i13.0o_;7.9
DATEOF
�Cy I�f�A
APPFI FOR ISSUANCE
PERMIT NUMBER
7y— �9
DATE
03* *4550
*4550
*4550,0'
B *000
6983;
1,0=(30'=79
- g 6479
i SPACE,
6 '914 4 z