1979, 12-03 Permit: 79-9034 Plumbing FixturesPLAN 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
JOB ADDRElal� ii y� si., LEGAL DESCRIPTION — SEE ATTACHED.-
�I A
LOT I BLOCK ISUBDIVISION PARCEL NUMBER/S
2:
0
CHANGE OF USE FROM I TO
6.
P4 0 NLE%
d�
ZIP
PHONE
aj2q���lT'`fe
�v
PHONE
ZIP
I YPL W, EW ❑ ALT. ,AAD'N. El RPL. 11MVE.
% WORK CdBD. . �PLMB. ElMECH: ❑ M.H. 1:1 POOL
-,OF ❑ OTHER
❑L
orth South
OWNER
ize of Parcel
3.
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions _included
L/
Type Const.
ADDRESS
Sprinklered
I
SQ2�
_
❑Yes ❑No . ❑ Req'd.
'aluation
CONTRACTOEL
DATE SIGNATURE
4.
DWL Area Tasement
Area
Garage Area
. ADDRESS
to
Env. Health
SEPA
/I 2
Split Entry
Split Level
DESIGNER
Co. Engineer
5.
No. Baths
ADDRESS
No. Rooms
0
CHANGE OF USE FROM I TO
6.
P4 0 NLE%
d�
ZIP
PHONE
aj2q���lT'`fe
�v
PHONE
ZIP
I YPL W, EW ❑ ALT. ,AAD'N. El RPL. 11MVE.
% WORK CdBD. . �PLMB. ElMECH: ❑ M.H. 1:1 POOL
-,OF ❑ OTHER
❑L
orth South
jEast West
ize of Parcel
Zone Classification
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions _included
Type Const.
Occupancy
Sprinklered
I
to give authority to violate or cancel the prodisions `of any other state or local law regulating construction or the
_
❑Yes ❑No . ❑ Req'd.
'aluation
Building Area in Sq. Ft.
DATE SIGNATURE
Mech.
DWL Area Tasement
Area
Garage Area
Storage
Env. Health
SEPA
Planning _
Split Entry
Split Level
Rancher
Co. Engineer
Other(Specify) `Ov
No. Baths
No. Floors
No. Rooms
Rec. Room
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
-CERTIFICATE
Req'd. _
Rec'd.
Not Req'd
of EXEMPTION
80 DESCRIBE WORK ^ ) (� a I FEES COLLECTED
PERMIT NUMBER
f� 0
DATE /� l .� 7q
03* *13,00
*13.00 IV-)
*13000
E *Q00
903.32
12-13=7;9
6479,
VALUATION Source 16 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. The granting of a permit does not presume
to give authority to violate or cancel the prodisions `of any other state or local law regulating construction or the
performance of construction.
Plumbing
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'O. RECD.
Plan Check
Env. Health
SEPA
Planning _
Fire Marshall
Mobile Home.
Co. Engineer
Other(Specify) `Ov
Utilities
TOTAL
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES APEIRMIT. A
12' Il 3• 9'0Z z *'1 3.0.0;a,�
DATE Q OFFICIAL
,7'`9'
,A
APPROVED FOR ISSUANCE
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