1979, 10-17 Permit: 79-6141 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 ADDRESS ,�^
,.
3e A � 912, h-[,hn rr� LEGAL DESCRIPTION -SEE ATTACHED
PERMIT NUMBER
DATE ZZ'
03* *30.50
*30.50
*3050
E *0.00
61 4.1 2
10-17-79
2 6.479,
VALUATION j Source GAS L CTRIC WATER SEWER
OWNER
of
9, Utilities
Single $
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
PHONE
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
Building
3.
'
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
Plumbing cl
3
DATE _ SIGNATURE
ADD Ess
SPECIAL APPROVALS SPECIAL CONDITIONS:
'
DEPT. REQ'D. RECD.
ZIP
Required Set Backs in Feet
Env. Health � � ( � �, SD ►. ^�.
�J
i 0L4
SEPA
Planning -n
,b
Fire Marshall
Mobile Home
Co. Engineer �1'4
!1 In
a.11Zl
Utilities
�.
North South
East West
A TOR
SEPA Checklist
THIS BECOMESA, PERMIT.
PHONE
Size of Parcel
Zone Classification
4.
jAESS
ZIP
Type Const.
Occupancy
Sprinklered
[]Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
Zip
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE NEW
ALT.
❑ AD'N. ❑ RPL.
❑ MVE.
7,
OF
El OTHER
Req'd. Rec'd.
Not Req'd.
WORK ❑ BLD.
X PLMS.
❑ MECH: ❑ M.H.
❑POOL
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
$
FEES COLLECTED
PERMIT NUMBER
DATE ZZ'
03* *30.50
*30.50
*3050
E *0.00
61 4.1 2
10-17-79
2 6.479,
VALUATION j Source GAS L CTRIC WATER SEWER
of
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 cl
3
DATE _ SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
I
Env. Health � � ( � �, SD ►. ^�.
�J
SEPA
Planning -n
,b
Fire Marshall
Mobile Home
Co. Engineer �1'4
Other (Specify)�L1lL
30-50
Utilities
TOTAL $�
Zone Cleai'ance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMESA, PERMIT.
f
IV
*30.50 SO) �