1979, 12-14 Permit: 79-9080 Water SoftenerPLAN 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
1.
2.
JOB ADDRESS j1 MI
LOT BLOCK TSUBDIV rON Ij\61
3
4.
5.
OWNER
l
LEGAL DESCRIPTION - SEE ATTACHED
ADESS
TOrt ^ - DOM
CONT
ADDrSS
DESIGNER
PHONE
ZIP
PHONE -
yS5—scs n
ZI`iq an&
PHONE
PARCEL NUMBER/S
Required Set Backs In Feet
North 'South East 'West
Sloe of Parcel Zone Classification
Type Const.
Occupancy Sprinkleretl
Oyes ❑No 0 Req'd.
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
•
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE 0 NEW
7. OF
WORK BLD.
DESCRIBE WORK -
$ LnA_/ VALUATION Q1&.
TO
Split Entry
Split Level
Rancher
0 ALT. 0 AD N. ❑ RPL. ❑ MVE.
0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
9.
Source
of
Utilities
MQk
GAS
ELECTRIC
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 to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
DATE
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATER'//Y/ !/OFFICIAL
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
O'0
TOTAL $
p
PERMIT NUMBER
-12- 90'60
DATE
03* *300
*300 to
*3006
E *G00
907.98
12-14-79
2 6479.
V Q.vt .vt nA--
APPROVED FOR ISSUANCE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1214.717'9' 9'08.02 *30;.0;°i
0
U
W
0
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