1979, 09-05 Permit: 79-3432 Residence 'LAN Nl MB=R APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 77- 3Az3c
s NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES O Z * * 1 0.0 0
JOB ADDRESS T1 LEGAL DESCRIPTION — SEE ATTACHED * 1 0,0 0 N
LO1. /BO CK SUB I ON, r / PARCEL NUMBER/S ♦♦ // „:1-.. ... -•� * 1 O.O O U
2. /./.) i (D 4-
-4L/ -'L��4... zi) ,/.L4i(/` PHONE r/Z� L3 K E * O.0 0 U
OWNER
�t�,� /�,(x�I. / �p ''�/-� ' � hi.6- .C�fc'/L"'t�SiJ J i� 3 5
3• DSR 55 -`�"-- '/ G� n P Required Set Backs in Feet /
2 7 0
l
1 c /� d�U� .dam_ 11 .�>r����' , qz, � 1�� North log? (South � East�1 West fv/ 0 8—2 4—7 9
CONTRACTOR 7 PHONE Size of Parcel Zonex� Classificatioyn n 4 7 9.
YlLL �1.C/1l,4.4/. 4-P- .--, :CLiil�, 4_
4' ApDRESS ZIP Type Const. Occupancy Sprinklered
1 �4.4 J Oyes ❑No CI Req'd.
DESIGNER/ PHONE Valuation Building Area in Sq/Ft.
�� n
5' ADDRESS ZIP DWL Area Basement Ar a Garage Area Storage
,.P 7 I -7GR ."a...
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. X
No. Baths No. Floors No. Rooms Rec. Room
TYPE I NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF CIOTHER / Req'd. Recd. Not Req'd.
WORK X BLD. ❑ PLMB. ❑ MECH: 0 M.H. POOL CERTIFICATE
of EXEMPTION X
1 DESC 8E WORK C-.4 )0 ` FEES COLLECTED
8. ,�/24j,�/»4i.-t_e_, ✓L-r-��- - iii -=" ^E.- c,l.wz.L cite
VALUA ION `) Source GAS ELECTRIC WATER SEWER
of
9. g�,OC) 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 41Q_9J
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 I cal law reg th)g Ponstruction or the Plumbing
performance of construction.
DATE('—',Q—V —2--7 SIGNATURE "t .. L Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. 1 -
Plan Check
(it {�/ "T j
Env.Health %1-0144 ✓t'
/ � A , SEPA
F
Planning fZ) &_ / 7Y
Mobile Home
Fire Marshall 's .( '
Co.Engineer ���" (' ���/ Other(Specify)
Utilities ' ,1 ,y, '
pL Rsf MAIL—
TOTAL $ .f!
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA ChecklistTHIS B COM A P MIT.-41011r �n
DATE OFFICI• 7�, ' U - '! aE 2 * 1 U. U LT
APPRO,ED IR ISSUANCE
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