1979, 10-11 Permit: 79-5771 ResidencePLAN NUMBER
`lf 52
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
1.
2.
3
4.
JOB ADDRESS
LO B
LOCDD K DIVISION /
8 3 �1 e-�` ey 4fnov- ,H Flo\c\.
O NERPHONE
A 0. L. 00\\..\.v•s 92x-5349
jz0ti: N. (aiim
FACTOR
ZIP
992/t
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/5 0/S.0.2.--,2.-50?-
/-arr L3LKS
/4,/�-Esk Eji I/4NOP. J,57- ADO
Required Set/ Backs in Feet
North �$ 'South
East 2"-1 'West 2-4'
Size of Parcel
/O't X /(e0
Zone Classification .
ADDREt){o .
ZIP
Type Const. ,•
Occupancy
M1 3
Sprinklered
❑Yes XNo 0 Req'd.
5.
DESIGNER
PHONE
ADDRESS
ZIP
V uation
oLp
4 /040
OWL/Area
IS2
Building Area in Sq/ Ft.
Basement Area Garage Area
894 I 012
Storage
CHANGE OF USE FROM
6.
TO
Split Enttrrry.
X J.W
q
Split Level
/
-t6-kLrr.�'.C3h56N'�l
Rancher
ONF/N/MFD- 6
TYPE
7. OF
WORK
C�JNEW 0 ALT.
BLD. 0 PLMB.
0 AD N. 0 RPL. 0 MVE.
0 MECH. 0 M.H. 0 POOL
0 OTHER
NO. Baths
2
No. Floors No. Rooms
7
Rec. Room
CERTIFICATE
• of EXEMPTION
Req'd.
Recd.
Not Req'd.
RESCRIBE YyORK
a. Ke s dance -Ocr
VALUATION
s. 57� Poo
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 stat• .r local law regulating construction or the
performanc of construction. '
DATE V ` ` ` 1 SIGNATURE , a •_ 1
5Q�CG
of
Utilities
tDec4- AtAlacAec/
r GAS
I/.
ELECTRIC
WAT8R
6/.e
'�SEWER
-"CP Gr/G
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health . /043 //e"... / -zir.,
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
z23-OI'CO - 1,L- 1 14-9_2_st A
G -t r}
DATE /o! ✓, OFFICIA
APPROVED FOR ISSUCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
2 4.'L1 -Q-
TOTAL
$ d6
PERMIT NUMBER
79-S 77/
DATE /D —��- 79
02* *212100
- *242;00 kui
*242006
E
*C000
577.0B
10-1:1L-79
�.a
6h79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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