1979, 08-10 Permit: 79-2009 Plumbing Fixtures PIAN NUMBER APPLICATION/PERMITcp PERMIT NUMBER I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 19
} NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 3* * 25.5 0
B ADDRESS
1. JOV, ti / '\
. RD. LEGAL DESCRIPTION — SEE ATTACHED * 2 5 5 0 N
LOT BLOCK / SUBDIVISION PARCEL NUMBER/S * 2 5.5 0 U
2. 9 - 1-i }-/-�e. 1 c k S d -Sc-I'3 D/u -s/d,-JE * 0,0 0 cn
3. O PHONE
/1 " -/ti - /6/'Is s- 2 0 Q 8 2
ADDRESS/ /t ZIP Required Set Backs in Feet
q‘/7// SS2 4 !a C North 'SouthEast (West 0 8— 1 0—7 9
CONTRACTOR PH.oNE Size of Parcel Zone Classification L 7 9n
SvcNR/SS 43e-ct.`1Ql,� -/712_ 6
4. ADDREg/ �1 ///� O ZIP 7 r / Type Const. Occupancy Sprinklered
v r /2-Z /'�-!� e�/E c7--.. l g.2._e_ ❑Yes ❑No ❑ Req'd.
DESIG ER PHONE Valuation Building Area in Sq. Ft.
rJ. 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
TYPENEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OFD OTHER -
WORK ❑ BLD. PLM B. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
$ /0 LG(/'T�-e(N _ FEES COLLECTED
VALUATION Source GAS ( ECTRIC 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 v
to give authority to violate or cancel the provisions of any other state or I. al law re ulatin! construction or the 2.5.
performance of construction. Plumbing
DATE C) /GJ'
SIGNATURE _Ar . =....-.-..c- Mech.
SPECIAL APPROVALS SPECIAL CON•ITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
CC
SEPA `o
Planning — Lo
or
Mobile Home "'
Fire Marshall =
Co. Engineer Other(Specify)
Utilities
TOTAL $
Zone Clearance
rWHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist t_!- ` THIS BECOMES A PERMIT. (�
DATE I� 9 OFFIC =• , G. � 0 8 1U — J h, +1. 9 7 * 2 5. 5 0 a ,7'
APPRA. -• FOR ISSUANCE _