1979, 12-05 Permit Void PLAN NUMBER
APPLICATION/PERMIT PERMIT NUMBER
I SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
!��/U LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBBDDIJVIS�J�^�� /�� Q • PARCEL NUMBER/S 2.76--„0,„ —6&iG
2 OWNS vT` A.GC�►'�I`(r PHONE A.DT 131-K-2, iittei&az./1µ�"4—
3. .R, ,u.44-zyz�d 92 fl—7392
ADDRES ZIP Required Set Backs in Feet
e, /z5-io ,,st,„,,, 99 4, North 441 1South S/ East /Q' (West /a/
CONTRACTOR
/
{ PHONE Size ofparcel Zone Classification
4.
ADDRESS ZIP Type C nst. Occupancy Sprinklered
A/14.4.4-- %..5.,4-12444-1-, ❑Yes ❑No ❑ Req'd.
DESIGNER 'IdPHONE Valuation Building Area in Sq. Ft.
5. 1/d0lSa /36" •
ADDRESS ZIP DWL Area I Basement Area Garage Area Storage —
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. .6:1).j
No. Baths No. Floors No. Rooms Rec. Room
TYPE
❑ NEW 24 ALT. X AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER -
CERTIFICATE Req'd. Rec'd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
of EXEMPTION
DESCRI E WORK lL / i
B ad jAr,
( 3/Z .9 3 ) FEES COLLECTED
VALUATION Source GAS T LECTRIC WATER SEWER
of � i
-
9, Utilities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included D
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building #/9 D' ,fiq
type of work will be complied with whether specified herein or not. The granting of a permit does not presumeto give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. ' PlumbingP-0/)
/� , I
DATE 7—3 — 7 9 SIGNATURE ts Al. 9t"—'_____. Mech. frii`
/
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA
I-
U
Planning w
— O-
M o b i l e
Mobile Home (/)
Fire Marshall
Co. Engineer Other (Specify)
Utilities
TOTAL $
a
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
DATE OFFICIAL _
APPROVED FOR ISSUANCE
44 4 44
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