1979, 08-14 Permit: 79-2163 Residence, Renewal of M6409PLAN 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
'�}'%' �Y�{`�[JA�Y�I/(�/./�/.{,,
' LOT 1 BLOCK SUBDIVISION �
2.
3A
I4ER
h4 41 d l3_e,a
AD RE5S
f°, /01/9 iY�szr.�9�
CONTRACTOR
4'
ADDRESS
DESIGNER
LEGAL DESCRIPTION - SEE ATTACHED
PHONE
9.G4SSF
PARCEL NUMBER/S 0 7SS3 -03//
K/, /SS ,$ 4• 9-97 y $TRACT i0 PLAT
G.RESNACRES /RR. OtsTRfar
ZIP
9i92 -0G
Required Set Backs in Feet
North 'South
East 'West
PHONE
5.
ZIP - -
Size of Parcel Zone Classification • -
6.,cyvu,44.// fit .,f770
5prin klered
Oyes ONo 0 Req'd.
Type Const.
Occupancy --
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area i I Basement Area
Garage Area1 Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE 0 NEW
7. OF
WORK 0 BLD.
O ALT.
O PLMB.
0 AD N.
0 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
2
No. Floors
• CERTIFICATE
of EXEMPTION
No. Rooms
Req d.
Rec. Room
Re 'd.
Not Req'd.
k
DESCRIBE WORK
8./VALLJ TION �G
VALUATION
9.
_ /
u NL—b X09 %�Q+Q.� /,�4�t.�C�
Source GAS ELECTRIC
of
Utilities
WATER
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 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 g-/•/ - 79
DEPT.
SPECIAL APPROVALS
REO'D. RECD.
SIGNATURE x ��
SPECIAL CONDITIONS:
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
DATL- /7—J 9 OFFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $ /�
Building t7
2%sE
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /g
04
PERMIT NUMBER
DATE Y-19— 7 9
Q2* *1800
*1800 ;
21622
Q8-14-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-i'4a77.9
216.3.0
*1 8. 0 0 °.r!'
0
U
W
Z