1979, 08-22 Permit: 79-2605 AC PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT M �� _ 2 ,O
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
04 * *700
JOB ADDRESS
t
1. , /1/21,Q LEGAL DESCRIPTION - SEE ATTACHED
it *7,0 0 to-
LOT BLOCK SUBDIVI ON PARCEL NUMBER/S *7 O O U
2.
OWNER P ONE, A *Q* 00 8
ADDRESS'' ZIPe �, Required Set Backs in Feet 2 6 Q 4 a
�. -.-e— L ///��� i i' • North
PHONE Size of Parcel South East West p r�
CON OR Zone Classification 0 8 2 2 / 9
/ 70� '-/l� 4 7 9.
4. ZIP,,....-%,, Type Const.47 Occupancy Sprinklered
ti G� { !�^' ! / ` r
Eyes ❑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.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ,'MECH: 0 M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK •
8. (1 �- FEES COLLECTED
.6"-%fl, a.e, a Z�1--' el--- "-(retz-L'-�e 3'r 4_,./
VALUATION Source GAS EL, Ec RIC WATER SEWER
of
"Z
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 arid 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 SIGNATURE_ Mech. /700
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA CD
o
Planning - w
0
Mobile Home cn
Fire Marshall —
Co. Engineer Other (Specify)
/-7e7-6
Utilities TOTAL $
Zone Clearance
A ! THIS BECOMES MACHINE A PERMIT.TED IN THIS SPACE,
SEPA Checklist
OWN
DAT •R7+ OFFI... A j 6--'----'-'''—"' 08 -22 _ (7
9 260. 5 * 7OQ EL 1--
APPROVE-11 FOR ISSUANCE _