1979, 10-05 Permit: 79-5418 ResidencePLAN NUMBER
12 —,�
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
1. B LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S ftjk—n.,A( 01C 3Zs,41-9063
TYPE Z�I'NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
% OF 11 OTHER
WORK "`-D. ElPLMB. ElMECH: ElM.H. 1-1 POO L
equired Set Backs in Feet
OWNER
PHONE
3.
Orth South
East West
ize of Parcel
ADDRESS
ZIP
S iL Q
ID
p
f
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
CONTRACTOR
PHONE
�S-.,prri�inklered
❑ Lyes fl'o' ❑ Req'd.
pluation
Building Area in Sq. Ft.
4'
ADDRESS)
ZIP
Basement Area
DESIGNER
PHONE
5.
Mech.
SPECIAL APPROVALS SPECIA CO ITIONS:
ADDRESS
ZIP
Level
CHANGE OF USE FROM
TO
SEPA
6.
No. Baths
No. Floors
TYPE Z�I'NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
% OF 11 OTHER
WORK "`-D. ElPLMB. ElMECH: ElM.H. 1-1 POO L
equired Set Backs in Feet
/ '4'
3o 1
Orth South
East West
ize of Parcel
Zone Classification
` ,
S iL Q
Type Const.
Occupan
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
co
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
�S-.,prri�inklered
❑ Lyes fl'o' ❑ Req'd.
pluation
Building Area in Sq. Ft.
0
S
DVIL Area
Basement Area
Garage Area
Storage
d
Mech.
SPECIAL APPROVALS SPECIA CO ITIONS:
Split EntrySplit
Plan Check
Level
Rancher
_
�P
SEPA
Planning 004 ru cr_ 2 3#0
No. Baths
No. Floors
No. Rooms
Rec. Room
Utilities
p�
TOTAL
Zone Clearance
N
CERTIFICATE
Req'd.
Recd.
Not Req'
of EXEMPTION I
PERMIT NUMBER
DATE .SE"r 12.1171
02* *238.00
*238.00Y
E *a00
541,78
10-05-79
@ 6.474,
DESCRIBE WORK
8
FEES COLLECTED
VALUATION Soofurce GAS ELECTRIC WATER SEWER
Off,
1 1
9. �i� Utilities 68 SEep-(iG
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
co
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
Building � t
type of work will be complied with whether specified herein or not. The gr Ing o a permit does not presume
to give authority to violate or cancel the provisions of any other state or I al aw egulating construction or the
performs ce nstruction. f
Plumbing
DATE SIGNATOR
Mech.
SPECIAL APPROVALS SPECIA CO ITIONS:
DEPT. RECQ'D. RECD. k 5o' rLNk wN j 6()'
Plan Check
Env. Health
_
�P
SEPA
Planning 004 ru cr_ 2 3#0
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
p�
TOTAL
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
,! ;,
THI$ B CO ESA MIT.
*238.00° -'
DATE ���_' OFFICIAL `-�
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