1979, 10-15 Prmit: 79-6021 ResidencePLAN NUMBER-
- -3
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DESCRIBE WCRRK
8 / FEES COLLECTED
VALUATION Source dAS ELECTRIC WATER SEWER
d e) of
Q, - 3 �-t,� ) Utilities Single $
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 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 lawregulating co.struction or the
performance of construction. Plumbing
DATE �J '�``i ' SIGNATURE '� G' Mech.
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE ^ 0FFICIAL`�'-�"4-'t
Plan Check
PERMIT NUMBE, R I
OZ
DATE 10 -- /S-
02* *23300
*233.00 N
*233,00
E *Goo 0.
60202
10-15-79
6,479,
C
SEPA C
F
c
L
C
Mobile Home
Other (Specify)
�7 Li
TOTAL $ - y�_�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS ,B COMES.A PERMIT.
� - -15'-79 602:15 *2'33,00°
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
oB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
1
LOT
BLOCK
ISUBDIVISION
PARCEL NUMBER/S
V 7
2.
U i" ESI -K -z
OWNER
PHONE
3.
VL -/A-
'�
/J > D
ADDRESS
ZIP
Required Set Bac s in Feet
North 119,_41 South East West
CO TRACTOR
PHONE
Size f Parcel
"a
Zo e Classif4cati
x r.t
�. ..� .
4.
-'�'
AD KESS
ZIP
Type Const.
Occupancy
d Sprinklered
/��C-�
VA
-
[]Yes o 1:1 Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
DWL AreJ.
Basement Area
Garage Are?
Storage
-;:� S
A � :.
15Z,>7
CHANGE OF USE
FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors i
No. Rooms
Rec. Room
TYPE NEW
❑ ALT.
❑ AD'N. ❑ RPL.
❑ MVE.
7.
OF
❑ OTHER
CERTIFICATE Req'd.
Rec'd.
Not Req'd.
BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
WORK
of EXEMPTION
DESCRIBE WCRRK
8 / FEES COLLECTED
VALUATION Source dAS ELECTRIC WATER SEWER
d e) of
Q, - 3 �-t,� ) Utilities Single $
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 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 lawregulating co.struction or the
performance of construction. Plumbing
DATE �J '�``i ' SIGNATURE '� G' Mech.
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE ^ 0FFICIAL`�'-�"4-'t
Plan Check
PERMIT NUMBE, R I
OZ
DATE 10 -- /S-
02* *23300
*233.00 N
*233,00
E *Goo 0.
60202
10-15-79
6,479,
C
SEPA C
F
c
L
C
Mobile Home
Other (Specify)
�7 Li
TOTAL $ - y�_�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS ,B COMES.A PERMIT.
� - -15'-79 602:15 *2'33,00°
i