1979, 07-11 Permit: 79-374 ACt.
[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
JOB
' ADDRESS SUBDIVISION
LOT
2.
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER ^ La
3 (/„/(/v -u -c e� - 72-7
ADDRESS
77Q
PHONE
0a4 -7/5a
ZIP
Required Set Backs in Feet
North 'South East 'West
4.
CO TRACTOR /)
.-Z 4'LliL/ d./a'tttGl^�i 9-j
ADDRESS / as �✓.
PHONE
-635--/7//
Size of Parcel I Zone Classification
ZIP
7c2.°aZ
Type Const.
Occupancy
Sprinklered
DYes DNo D Req'd.
5.
DESIGNER
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE 0 NEW
7. OF I
WORK D BLD.
D ALT. ��0,/AD N. 0 RPL. 0 MVE.
D PLMB. ILr MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
Source
of
Utilities
GAS
ELECTRIC
X
WATER
SEWER
I hereby certify that I have read and examined this applica ion and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correc . 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 SIGNATURE
DEPT.
SPECIAL APPROVALS
REDID. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
4a4L . OCL J
DATE
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ a—c,
DATE
PERMIT NUMBER
79-37�
04* *7.00
37.3fi
07=11-79
A 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-111779 3 7,4Z *7.0.0 2.0