1979, 11-01 Permit: 79-7098 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMITP PERMIT NUMBER
SPOKANE COUNTY BUILDING CODES DEPARTMENT
t NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES Q 3 * * 3.0 0
1. JOB ADORES$ i���
S 4 LEGAL DESCRIPTION — SEE ATTACHED * 4 3.0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S * 4 3.0 0 c:
2.
. ate"- Gt t 5 P t — E * 0,0 0
CD
3. p# frZ ie c, n
ADDRESS ` ZIP Required Set Backs in Feet 7 0 9.7
11 `'7 E 4yk',,cl 1—k.c North 'southEast (west 1 1 —0 1 —7 9
q.o_N TRAq�CTOR PHONE Size of Parcel Zone Classification
/11,1CC — I ot.ut6 — 1-1.114,0 6 4 7 9,
4' AD ESS Type Const. Occupancy Sprinklered
��2 cE 4sl' sbau ❑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 XNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. El MECH: ❑ M.H. ❑ POOL
of EXEMPTION
DESCRIBE WORK
8. % 0 t y�` l e, 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 gr:nting of a perm does not presume
to give authority to violate or cancel the provisions of any other state or lo•:l law regulatin.: lb onstruction or the //Coo
performance cons ruction. / Plumbing
DATE if SIGNATURE / !lam ~' Mech.
SPECIAL APPROVALS SPECIAL CONDIT •NS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health cp
SEPA `D
Planning — ..i
2
Mobile Home ,i,
Fire Marshall
Co. Engineer Other (Specify) 3%
Utilities TOTAL $ 4t�U4
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
� THIS BECOMES,A PE MIT.
SEPA Checklist r. ?11 - 01 - 7 n8 *4 3, GJ ? F
DATE/id �79, OF A _ - .
A'"S ED FOR ISSUANCE -