1979, 08-28 Permit: 79-2955 ACPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
/q/7
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
3
OWNER / _
ADDRESS
PHONE
ZIP
PARCEL NUMBER/S
Required Sot Backs in Feet
North 'South
East 'West
4.
5.
CONTR FTOR
PHONE
Size of Parcel Zone Classification
ADDRESS
y � � 707e
DESIGNER
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
OWL 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.
0 AD N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. &A-42 J ei--/ tt t&t-ei7t4 k v
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
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 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 f construction.
DATE 4t° 024/7/ SIGNATURE -
DEPT.
SPECIAL APPROVALS
REQ'O. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DAT
�1=8/79
OFF
APP
FOR ISSUANCE
FEES COLLECTED -
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$
TOTAL $
PERMIT NUMBER
-
9/.27
0
*7.00
*7.00 .�
*7008
A *Q00 8
29S4f
08-28-79
a 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0&-.2i8=7'9
295.58
*700a�
0
U
uJ
a