1979, 10-17 Permit: 79-6119 Plumbing FixturesPLAN NUMBER
APPLIeATION/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. R.I BL1CG ten .
LOT B OCK SUB IVISIO
2.
OWNER
a. amIWA �cX .,-0r"sn
S
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHON
wiz -9tz3
ZIP
Required Set Backs in Feet
North 'South East 'West
CONTRACTOR
a. -�� �Jkutpie
ADDRESS /
Res i c -t. i rl�Ka pet
DESIGNER
5' ADDRESS
PHONE
Size of Parcel - Zone Classification
Type Const.
Valuation
Occupancy Sprinklered
❑Ves ❑No 0 Req'd.
Building Area i Sq. Ft.
ZIP
OWL Area Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
CI NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 OTHER
❑ BLD. PLMB. 0 MECH: ❑ M.H. 0 POOL
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE WORK
8.
11 I Q
it) Y1 ON `
9.
6
source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this application and have read the "NOT.ICE" 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 /c-onstrucction.
DATE J 0 w! 40 -19 SIGNATURE.
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE!// /( -nOFFICIALR4/A7J( -fe- . 1
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing 2g
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
DATE
PERMIT NUMBER
71
-i(` 79
03* *2800
*2800
*.:!8006
E *000
611.82
10-17-79
B 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISi COM APE MIT. q * O
f0 '1 ,-1179- 6'1192 28.0,0aH