1979, 11-16 Permit: 79-8010 Insert PLAN NUMBER APPLICATION/PERMIT ^,� PERMIT NUMBER I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT '.' �l g J ��
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS i2 LEGAL DESCRIPTION — SEE ATTACHED * 7,0 0 n
H1. OCKQ �. �PI�'I r � - o o,9
LOT BLOC SUBDIVISION PARCEL NUMBER/S 1,9
2.
OWNER PHONE 1 1 — 1 6—7 p
3. `ra1R 10 /1 n
ADD EELS ��'{yam f C �/,,� ��/� ZIP �� Required Set Backs in Feet a 4 7 7.
6F IQ 'r I Jr49F94IA,C� , North 'SouthEast (West
TRA
CONTOR PHONE Size of Parcel Zone Classification
4. ADDRESS ,I��vv�nlll ZIP Type Const. Occupancy Sprinklered
❑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 ,,_,� No. Baths No. Floors No. Rooms Rec. Room
Lr/J NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ,_,.,/ ❑ OTHER -
WORK ❑ BLD. ❑ PLMB. LK MECH: 1:1 M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. ri K6r1 I i r I ceI (no-J
✓i�� 1
5")
II 1 FEES COLLECTED
VALUATION Sou GAS ELECTRIC WATER SEWER
of
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 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 co• ..n or the
performance of construction. Plumbing
DATE �� \ tP �� SIGNATUR I _ Al A.. .. /AA T 1 �� pO
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA O
F—
Planning U
— w
2
Mobile Home co
Fire Marshall
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist / //// r THIS BECOMES A PERMIT. (
DATE l' /f4 O' ICIAL t' _ 1 1-116 -7 1 ; 1. U �' * /7
. 0 (0
_
' .a,�
A"'0 6 OR ISSUANCE