1979, 10-15 Permit: 79-6028 Toilet PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT P ---0- V �2�
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES Z
JOB ADDRESS ` / ) 3 i" 0 * * 5.5 0
1. _ 1 /c;?S 7 LEGAL DESCRIPTION — SEE ATTACHED * 5 5 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2. /} /Et/'/ '\* * 5.5 O�fco
O W N E "-'�'�-K�iL/' l..t. J e;r)0 Y AC�V 6 E �7 * O.0 0 0
3eARESS
/2s' /9 / ZIP
North Required Set Backs'SouthFeet East 'West 0 2• /
C TRACTOR ;FIRE Size of Parcel Zone Classification 1 0- 1 5-7 9
- #' ' - _in) 2
4. RES �) ZIQ� Type Const. Occupancy Sprinklered Q 4 7 9.
`,` � 32 G� 41 l.'' ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF Cl OTHER
WORK ElBLD. PI PLMB. ElMECH. ❑ M.H. 1=1POOL CERTIFICATE Req'd. Recd. Not Req'd.
of EXEMPTION
I DESCRIBE WORK
--/-7;;44L- -- FEES COLLECTED
VALUATION (-Source GAS ELECTRIC WATER SEWER
of
9. Utilities Single $
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 Building
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. Plumbing
DATE SIGNATURE_ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA c
I-
Planning L
LL
a
Fire Marshall Mobile Home v
z
Co. Engineer Other(Specify) //))
Utilities i
TOTAL $
Zone Clearance 1111 ^. ..
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist /JQ - THIS B�COMES 5:'71'.9 ARMIT. L,O..�.O Z *�5�rt aF
DATE 105 //OFF� I � 1 11 U 0
APP'o• D FOR ISSUANCE