1979, 12-18 Permit: 79-9232 Mechanical7eBER
PA&AN
Z::JOB ADDRESS
Al 17 0
— OWNER
ADDRESS
g4M0
CONTRACTOR
4. ADDRESS
Ea ff
DESIGNER
5' ADDRESS
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES – PRESS HARD TO MAKE 4 COPIES
2 S A R F/ I LEGAL DESCRIPTION – SEE ATTACHED
ISUbUlVlZ:,1U1N I PARCEL NUMBER/S
/?iv cc.e -Ai
0 IV 74 .1 AIN Ir- /?
PHONE
4 1 q
ZIP -
Required Set Backs in Feet
Split Entry
f41 20
North South
East West
P ONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
q �+
, I I--4 1r
No.
Rooms
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
CERTIFICATE
Req'd.
Recd.
ZIP
DWL Area
Basement Area
Garage Area
I Storage
�J" PE T_NUM 9R Z
DATE
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE ❑ NEW 1:1 ALT. �AD'N. El RPL. ❑ MVE.
No. Baths
No. Floors
No.
Rooms
I Rec. Room
EOTHEIR
CERTIFICATE
Req'd.
Recd.
Not Req'd.
7. OF
❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
WORK
of EXEMPTION
DESCRIBE WORK C
S r J. L F L, e' T' 1? f 4 f? ill A C F 4 9 'r /%J ye
FEES COLLECTED
8. 1
VALUATION Source GAS ELECTRIC WATER SEWER
�% }y of
9 (� 0 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
work will be complied with whether specified herein or not. The granting of a permit does not presume
type of
to violate or cancel the provisions of any other state or local law regulating construction or the
to give authority
Plumbing
of construction.
performance
Z^' 9 SIGNATURE /y! �1.�/�Gt�''; ��
DATE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
•
Utilities
TOTAL $ / 1
Zone Clearance
WHEN MACHINE VALIDATED
I
SEPA Checklist -/'/JjjG O F F I c, A L ,�f�`�o�t J
DATE �!3�
THIS BECOMES A17PE�jRMIT.
12
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12-18-79
;H 6479,
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