1979, 07-26 Permit: 79-1061 Plumbing FixturesI� '.AN NUMBER APPLICATION/ PERMIT
PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
DESCRIBE WORK
8 / ✓ s� FEES COLLECTED
VALUATION SourceGAS 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.T a ting of a permit does not presume
to give authority to violate or cancel the provisions of any other state r I ca law r ti construction or the
Plumbing
performance of construction.
DATE SIGNATURE _ Mech.
SPECIAL APPROVALS SPECIAL C (TIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer Other (Specify) -
0 3
Specify)
03* *40.50
*4050 to -
4 0 5 0 6
o-40506
B *0,00 00
10602
07-26-79
2 6479,
Utilities/1
TOTAL $Z
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS ffOI EyS A �E�MIT.
^'� LL �bj 01 6 z
*40,50°=
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1.
S
JOB ADDRESS ,
OQ 1
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
2.
I
OWNER
PHONE
3.
ADDRESS
ZIP
Required Set Backs in Feet
North South
East West
CONTRJgTOR
PH
Size of Parcel
Zone Classification
4.
AD RESS
ZIP
Type Const.
Occupancy
Sprinklered
Dyes []No ❑ Req'd.
Grff4GP R
i'
P AF
✓
Valuation
Building Area in Sq. Ft.
5.
cJ1
A DRESS
�vp
ZIP
DWL Area
Basement Area
Garage Area
Storage
5,
I�, lNd�
0"
r
CHANGE OF USE
FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE �VEW
1:1 ALT.
ElAD'N. El RPL.
ElMVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
v
OF r
El OTHER
❑ BLD.
ElMECH: ❑ M.H.
❑POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
8 / ✓ s� FEES COLLECTED
VALUATION SourceGAS 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.T a ting of a permit does not presume
to give authority to violate or cancel the provisions of any other state r I ca law r ti construction or the
Plumbing
performance of construction.
DATE SIGNATURE _ Mech.
SPECIAL APPROVALS SPECIAL C (TIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer Other (Specify) -
0 3
Specify)
03* *40.50
*4050 to -
4 0 5 0 6
o-40506
B *0,00 00
10602
07-26-79
2 6479,
Utilities/1
TOTAL $Z
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS ffOI EyS A �E�MIT.
^'� LL �bj 01 6 z
*40,50°=