1979, 11-01 Permit: 79-7129 Mechanical FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
04* *7,00
*7.0G
*7.006
E *a0C
71 2,8;?
1 1 —01 —79
2 6,479,
VALUAI IUN
PERMIT NUMBER
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
-
JOB ADDRESS
9.
of
utilities
X
LEGAL DESCRIPTION — SEE ATTACHED
1
LOT
BLOCK
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
PARCEL NUMBER/S
2.
Building
ISUIIVISI
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
OWNE
performance of construction.
PHONE
3.
06
DATE SIGNATURE _
Mech.
SPECIAL APPROVALS
ADD SS
ZIP
Required Set Backs in Feet
Plan Check
°
North South
East West
CONT O
Planning
P?Ljj0NE
Size of Parcel
Zone Classification
Mobile Home
Fire Marshall
4..
Co. Engineer
Utilities
ADD SS
TOTAL $
ZIP
Type Const.
Occupancy
Sprinklered
O
2
SEPA Checklist
r
THIS BECOMjES A PERMIT.
1
❑Yes ❑No ElReq'd.
I. I 1
DESI NER
�; _�_ ,. i ='
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 NEW
El ALT. ElAD'N. El RPL.
ElMVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
WORK ❑ BLD.
�I
❑ PLMB. MECH: ❑ M. H.
❑ OTHER
❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
/
of EXEMPTION
8
DESCRIBE WORK
FEES COLLECTED
04* *7,00
*7.0G
*7.006
E *a0C
71 2,8;?
1 1 —01 —79
2 6,479,
VALUAI IUN
PERMIT NUMBER
M
-
DATE
04* *7,00
*7.0G
*7.006
E *a0C
71 2,8;?
1 1 —01 —79
2 6,479,
VALUAI IUN
Source GAS
ELECTRIC
WATER
SEWER
9.
of
utilities
X
Single $
1 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
+7 0-4
DATE SIGNATURE _
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
r
THIS BECOMjES A PERMIT.
I. I 1
DATE `" OF - I_
�; _�_ ,. i ='
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