1979, 08-10 Permit: 79-1971 Residence-.CAN NUMBER
/I R-.36
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
•
PERMIT NUMBER
`-77 V9-7(
(
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1
2.
JOB i 'O f A\75,,/i
LOT BLOCK �SUB�D ikiI
ON
II/vJ t w A pn- fl00
�� c cil Fil' 09. iNC, V I zf7E7t17
OWNER
ADDRESS
5
CONTRACTOR
SAM 6
ADDRESS
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/5
oq 542. – 0703
Required gJ
Set Backs in Feetet
North / (South O [Ea
Size of Plaice! cer1
(West I%–
Zone Classification
ZIP
Typ; const.
C ccu pa n cy
6prinklered
Dyes ❑No 0 Req'tl.
DESIGNER
5' ADDRESS
PHONE
Valuatlor
BuildinAreea jSq. Ft
Area
ZIP
CHANGE OF USE FROM
ILd NJ:W
6.
TO
OWL Area 12:ogee/on
978 um r
Split Entry Split Level
Garag 1 Storage
Ranche
TYPE
7. OF'
WORK
0 ALT.
(((iii��–���PLD. 0 PLMB-
❑ AD N.
❑ MECH
❑ RPL.
o M.H.
❑ MVE.
❑ POOL
0 OTHER
No. laths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd
Recd
Not Reg d.
8.
DESC'4f NQR rAy I ��
VALUATION Source
9. ?/ Od0Utilities
GAS
ELECT
WATER
SEWER
iG
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
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 re.ulating constr ction or the
performance of construction.
'_/
11— / SIGNATUR'11111. . w Cr
DATE
DEPT.
SPECIAL -APPROVALS
REQ'D- RECD
Env. Health v
—lyyl/I/ 71/7/79
Planning -
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
'0I46r- .w4-
ry'�I ia% ` �blV��c�l
t/ ik/ :2,75 Ec�% ri c
eoTtn cdrP«S
DATE
0
9OFFI
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
02* . *5000
*5000 t6
*5a006
E' *000 8
197.01
08-10-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE
THIS BECOMES A PERMIT.
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