1979, 07-23 Permit: 79-862 Renewal of Cond Usef "r
PLAN NUMBER
a.
JOB ADDRESS
LOT BLOCI
1 15
2 OWNER
3. `� 09 1,
ADDRESS
i J
r5r I I /C
CONTRACTOR
4. ADDRESS
DESIGNER
5. ADDRESS
APPLICATION/ PERMIT
SPOKANE COUNTY - BOLDI'NG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
aluation
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIV SIGN
I Basement Area
���
Storage
PARCEL N�MBER/SL�
o�A4- - 081 E3
Split Level
PHONE
No. Baths
1
PlNorth
No. Rooms
ZIP
CERTIFICATE
of EXEMPTION
Required Set Backs in Feet
South East West
_
Not Req'(
PHONE
_
Size of Parcel -
Zone Classification .-
ZIP
PHONE
ZIP
CHANGE OF USE FROM TO
6.
TYPE ❑NEW ❑ ALT. ❑ AD N. :1RPL. ElMVE.
% D• 1:1 PLMB. ❑ MECH:/ ❑.M.H. El POOL ❑ OTHER
WORK E) Er
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
aluation
Building Area in Sq. Ft.
DWL Area
I Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
I Recd:
Not Req'(
DATE
DESCRI WORK
8 I D G��/) - - FEES COLLECTED
V Vr
VALUATION Source GAS ELECTRIC WATER SEWER
9, Utilities
Single $
1 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. �N� Plan Check
Env. Health✓'Y ' " O� ��� �� ~ ��
�r 00 SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer Other ( peci y)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN
-SEPA Checklist ` THIS BECOMES A PERMIT.
DAT7Et2"11/-77 OFFICI 0 742 3"79
APPRO FOR ISSUANCE
+ PCRMIT NUMBER
7 P&2
02* *SOO
*S00 N
8619
07-23' 79
.@ 6479.
86,22 .00,a,PJ.—
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