1979, 10-25 Permit: 79-6697 DampersrIVLAN NUMBER
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1
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
3013-ADDRE-SS
t • f ii Via
6/[aet!
LOT BLOCK
OWNER /
3 4 0/ 0,0 t t Ra t ve y
ADDRESS
E//gra 6acc
CONTRACTOR�(' ,�
4. 7 —41 /2 Li44/ l -y1 �f�0/i'r , /.r.0
ADDRESS
/,a 7/0 /.vf%45s---cc//Sdiv,vr !/<
DESIGNER ((//
2.
5.
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
5;2? --5-C-12
ZIP
yqa/�
Required Set Backs in Feet
North (South East 'West
PHONE
Size of Parcel 1 Zone Classification
ZIP
fla/
Type Const.
Occupancy
Sprinkleied
❑Yes ❑No 0 Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH.
❑ RPL.
❑ M.H.
O MVE.
O POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
$
9.
DESCRIBE WORK / //
/ ¢ / Ya n A-te at.? R
VALUATION /1
Source
of
Utilities
sc.✓/a,c,..rrce f !e«c -t/i'K.y sAai , v C.... 46i,<
WATER SEWER �rKi
GAS
ELECTRIC
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.cti
DATE /a - A - 7/ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/l
6� s«�t
Of Cs "Ay
/o -2s -t9
DATE OFFICIAL
APPROVED FOR ISSUANCE
• FEES COLLECTED
Single $
Building
Plumbing
•
Mech.
610.499015 et2
Pian (,/heck
SEPA
Mobile Home
Other (Specify)
TOTAL
$9,vd
PERMIT NUMBER
79 -6697
DATE/ 40 —ZS -79
E
6`69.6
1 0-25-79
a 6479
*7.00
*7.00
*7.008
*Q00 8
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10::_,,2.5;17, 719
669;72 *7.0.0,21
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