1979, 07-26 Permit: 79-1091 Pool46
l
PLAN 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
1.
2.
3
JO DDRES�
NIM
LT
BLOCK
13V
W
SUBDI 151°NealN j�`( r
1
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
ALLMJ P
Af RfjC7 1.o0 tr
ti
PHONE
9)3- 5
PARCEL NUMBER/Si
I7C1-3 - 11007
foe
Required Set Backs in Feet
North (South 10
East 1 0 West
uired Set4rAt
4.
ADDRESS
PHONE
Size f P el
Pz�x 3
ZIP
_ Type Const.
Zone Classiflc ion
01Ut�Rf€,,
Occupancy S rinklered
❑Ves Digo 0 Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
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. 0 MVE.
❑ M.H.POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Reed..
Not Req'd.
8.
DESC RIB WORKe-AffilkAri.1 ra9V
9.
VALl7ATI ON
Source
of
ULIIII IeS
GAS
ELECTRIC
WATER
SEWER
41 DDO
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.
DATE 7'—.24 '79 SIGNATURES _.��
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE 124- (/ O F FI CI A L Wirr^" lYW'.r' t
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (SpecifyY 0
I' Wli
TOTAL $
PERMIT NUMBER
79-107/
DATE
Boz
*27.00
*27.00 t5
*27.006
A *0.0o
10902 -
07-26-79
f 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 7 2'67.7 9 10 9.12
* 27.0 ,0 a
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