1979, 08-10 Permit: 79-1975 ResidenceAN NUMBER
ef. 35
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
I5E55 ✓ c✓1/ I 6
LOT BLOCK r �V
2. I2 I
OWNER � ✓ `� �+
3 . 0C I or
AD RES Y
8I5 6r ro oor7
CONTRACTOR
iF
ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
SUBM ISION tAi A490
4.
PARCEL NUMBE /S
O9 S 2 -4703
Required Set Backs in Feet
North !South 3 0
PHONE
East !� !West 41
Size of Parcel Zone Classification.
'
<411i110
ZIP
Tgpe .Const.
OrcupancY
If2�,3
Spnnklered
Dyes ❑Na 0 Req'd.
5.
DESIGNER
PHONE
Valuation Buildin9_A ea in Sq. Ft.
ADDRESS
ZIP
OWI Area I Basemept Are Garage A ea
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
SplYt Level
Rancher
TYPE L)TNEW
7. OF
WORK
8.
9.
ly BLD.
DESCRIBE WOfRKK
YI�� L—
❑ ALT.
O PLMB.
O AD N.
❑ MECH.
O RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Ryoms.
RecceRoom
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
VALUATIO
'AM I,L---(
Source
of
Utilities
GAS
ELtCTT IC
t'AER
��Ti
SEWER
25, we
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 provisiohs of any other state or lo al law regulatitt j onstruction fl the
performance of construction.�
DATE / (7- 4 1 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Hoalth
Planning
2/7/s'/79
7
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
6Nt5-1)\-1•eci- Na roic
2-1" eir:Jedirva- pew,
DATE
•
AP
OR ISSUANCE '
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
A
Mobile Home
Other (Specify)
TOTAL $
r, n
PERMIT NUMBER
/ -19 75
DATE
02* *5000
*5000 >n
*5000,5
E' *000 S
197.4'2
08-10-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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