1979, 08-10 Permit: 79-1996 AdditionPLAN 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 1. I7°
4-
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3
AD CIFtESSF'7o 4 I I ✓1A 1
PHONE
72+2
PARCEL
O. gNUMB f R/S v, 5X1741 OF c3 l 4-I —%04;
X17 I+2�°-4,4090 'ogibitAF-ps
Required Set Backs in Feet
North 'South
East 'West
CON9CTpR
4. VI
ADDRESS
PHONE
Size of Parcel
Zone gla;sifi a ion
ZIP
Type Const.
Occupancy Sprinklered
Dyes DNo 0 Req'd.
5.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
9'040
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Story age
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
YJ W
BLD.
D ALT.
D PLMB
(�D N.
0 MECH.
D RPL.
❑ M.H.
D MVE.
❑ POOL
D OTHER
No. Baths
No. Floors
No. Rooms
Rec.
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
9
Kc
DESCRIBE t2h* I'"L Aro' o' �Io'J
ELECTRIC
VALUATION
Source
- of
Utilities
GAS
WATER
SEWER
/IW
I hereby cer ify that I hale 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. he granting of a permit does not presume
to give authority to violate or cancel the provisions of any other sta r local law regulating construction or the
performance of construction. c
DATE 0 d ' (L�' 7? SIGNATURE
I/IiI.J
DEPT.
SPECIAL APPROVALS
REQ'D. - REC'D.
\ Env. Health
I.
Planning
h. J */(97-77
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
ST f M'1 N O‘Oq
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
.tii
PERMIT NUMBER
19=19'76
DATE
02* *111.00
* 1 1'1.00 In
* 111.006
A *GOO 8
199.5&
'08-10-79
2 6.479.
DATES7'4-75 OFFICIAL
APPROVED FOR ISSUANCE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-10 79 199.65 *1110.0a-12'.
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