1979, 12-31 Permit: 79-9683 Water HeaterIF -LAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
� { PE RMI T NUMBER
DATE
PERMIT
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
0 3 *
* 75 0
ADDRESS
JOB
LEGAL DESCRIPTION — SEE ATTACHED
rr
* 50
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
2.
*75065
^
O
PHONE
3. A �C
9 6 8.2
ADDRESSZIP
Required Set Backs in Feet
�A
North South
East West
2 — 7J — 7 9
CONT ACTOR
PHONE
Size Parcel
Zone Classification
of
,✓
2 6,479,
4' ADDRESS
J
ZIP
Type Const.
Occupancy
Sprinklered
,.,3�^d /f / �✓
❑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.
TYPE El NEW 1-1 ALT. ElAD'N. Ifs RPL. ❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7, OF El OTHER
CERTIFICATE
Req'd.
Recd.
Not Req'd.
1of
1:1 BLD. BLD. PLMB. ❑ MECH: ❑ M. H. ❑ POOL
WORK
of EXEMPTION
I
DESCRIBE WORK FEES COLLECTED
8
VALUATIGN.
Source
GAS
ELE TRIC
WATER
SEWER
9.
of
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 J -2— SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
i
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
IN THIS SPACE,
SEPA Checklist
THIS BECOM EIS APERMIT.
r�
5
DATE OFFICIAL-)--
1 1