1979, 10-03 Permit: 79-5216 Addition, Renewal of M0524ILAN NUMBER
•
, i i
. 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
2.
JOB ADDRESS
LOT (1)1c,<-5-su2/46-tte-o—mi
LEGAL DESCRIPTION - SEE ATTACHED
OW
3. NERIk'-t,-Lt CL f L
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AD RESS p p
e . /O /4.5-14/.A[ ?.q>f�t/ ��1 .f lleMer (
CONTRACTOR
4444 P
4' ADDRESS
sad titlA
PHONE
9.24L -,a5" 7l)
PAARCEL NUMBERS ll ,�!/ 6379
,c-41 iv J y DTT/ x3A-A" 3/,
BPP. EC, w, AD
ZIP q
,246
Required Set Backs in Feet
North 'South
East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes 0No • 0 Req'd.
5.
DESIGNER
PHONE
Valuation 1 Building Area In Sq. Ft.
ADDRESS
ZIP
DWL Area
Basement Area 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
❑ NEW
O BLD.
O ALT.
O PLMB
O AD N.
O MECH.
O RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No.
Baths No( loors
Aid
CERTIFICATE
of EXEMPTION
N o.jioo ms
Rec. Room
Req'd.
Recd.
Not Req'd.
\ 8.icaNtetafaX
DE RISE WORK
VALUATION
9.
(itSource GAS t)-1
CGATER
J
of .
Utilities
SEWER,
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. Th • anting of a permit does not presume
to give authority to violate or cancel the provisions of any other state . Io al law regulatinconstruction or the
performance of construction.
DATE / 6- S -7y SIGNATURES
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE/ FFICIAL �'L.yt10(1A/rib
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
79
DATE/4-'
02* *1600
*1600
521.52
10-03-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'0
51L6 *16,0,0'°1,
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