1979, 11-19 Permit: 79-8128 ResidencePLAN 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
LEGAL DESCRIPTION — SEE ATTACHED
2 LOT I BLOCK SUB�VISION I Ano �a� PARCEL NUMBER/S I6 or
- j707
OWNER
3 ADDRES
C�Of�TRA _
4. ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
0C,
i
PHONE
77�-555
ZIP
X3.3
PHONE
ZIP
PHONE
ZIP
uired Set Backs in Feet
:h �0 South v East O
of Parcel Zone Classi
X S�
Type Const. I Occupancy
aluation
/ Brea Bas,r
Split Entry
No. Baths No. Floors
5
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
6
Garage Area Storage
f-
/
.evelI Rancher
No. Rooms Rec. Room
I yrt L!f NEW ❑ ALT. ❑ AD'N. ❑ RPL.
❑ MVE.
Z„
], OF/
1-1 OTHER
CERTIFICATE
Req'd.
Recd.
N to Req'd.
WORK BLD. 1-1PLMB. 1-1MECH: ElM.H. ❑POOL
of EXEMPTION
DE CRIB WORK
$ /
�/
G a
FEES COLLECTED
VALUATION Source GAS
E C RIC WATER SEWER
Of
e,
9. Utilities
V
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 o o al law regulating construction or the
performance of construction.
Plumbing
G; J"
DATE
SIGNATURE 'r
Mech.
SPECIAL APPROVALS
SPE ONDITIONS:
DEPT. REQ -D. RECD.
00 pL'T
Plan Check
Env. Health iO
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
f�
Other (Specify) -
Utilities
,
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATE
SEPA Checklist
THIS BECOMES A PERMIT.
&A7i Ic 6rd
DATE 4 J12 OFFICIALG'�yJ�g���r1.1
® PERMIT NUWBER
DATE /I"/� — 79
'i
1 2,
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`3
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igge , 41o?
e 0 iq+vod co.crflid
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F10019 — 9ep