1979, 10-05 Permit: 79-5401 Renewal Permit GaragePLAN NUMBER
CHANGE
APPLICATION/ PERMIT
to give authority to violate or cancel the provisions
of any other state, or local law rI ' constr tion or the
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
performance of
onistructon.
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Plumbing
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
1.
SIGNATURE
CR
SPECIAL APPROVALS
LOT
BLOCK
SU DI I ON
PARCEL NUMBER/S ,34 it -0)09
2.
FFNiFWA!L OF I-MPA(T NO.
Plan Check
of TRR�T io5' aF �JEsT FhRN�S IRR.
SACC S. 5.47.70' 440 EXc N.
OWNER
PHONE
ZZ
2-4-1 ROAN
3.
SEPA
Planning
-
ADDRESS
ZIP
Required Set Backs in Feet
1,566 PINELS
5Fb1KAt4E1
179206North
South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
Other (Specify)
Co. Engineer
XI
c
4'
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
P -
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
o
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
--
-
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. 7�
No. Baths I No. Floors No. Rooms I Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF O OTHER ^-
WOR El BLD. E3PLMB. ElMECH: ❑ M.H. El CERTIFICATE Req'd. Recd. Not Req'd
of EXEMPTION G�
D IB
8 6 FEES COLLECTED
VALUATION Source GAS'ELECTRIC WATER SEWER
of rA S>E 9. O utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
�2
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this I 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 rI ' constr tion or the
performance of
onistructon.
/
Plumbing
/.
DATE
SIGNATURE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT.
REQ'D. RECD.
FFNiFWA!L OF I-MPA(T NO.
Plan Check
Env. Health
O J
V
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
DATE
OFFICIAL- --
PERMIT NUUMBE/R,
J U
DATE j0 —4'717
02* t2C�i
54rC'
1 0-�
( �I Q _
TOTAL $ 6a'_
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
c_
LL
CL
V
z