1979, 08-13 Permit: 79-2021 AC PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT Al 7, J .7)--(7. --. ,
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE 79
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD YO MAKE 4 COPIES 0 4 * *7.0 0
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED *7,0 0 N
1. S . YU// f� *7.00
LOT BLOCK SUBDIVISION' PARCEL NUMBER/S
2.
A * 0,00
OWNER PHONE
3. ,44 $ mess. eer^P_, inea� 47,-7% 20208
ADDRESS ZIP Required Set Backs in Feet 0$ 3—7 9
sSa4").\p� c�k'4i9lr% North 'South East 'West
CONTRACTOR PHONE Size of Parcel Zone Classification 2 6,4 7 9
4. ADDRESS \a'/ ZIP Type Const. Occupancy Sprinklered
Dyes ❑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. 0 AD'N. 0 RPL. 0 MVE.
. OFf� ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK ❑ BLD. 0 PLMB. MECH: 0 M.H. 0 POOL
of EXEMPTION
DESCRIBE WOR0--",---
FEES COLLECTED
8. o'?*—
VALUATION Source 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 construction or the
Plumbing
performance of construction.
DATE SIGNATURE Mech. 3 '06
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health r
SEPA o
I—
_ U
Planning ``
0
Mobile Home
Z
Fire Marshall
Ao(ldoh1"y.�Jd
Co. Engineer
Utilities TOTAL $ 7.C
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist �7/i/ } ' THIS BECOMES A PERMIT.
DATE`' {(1 'OFF ICI• \- '/ v--� U — 1 — % 1 * 7 o I
APPRO ED-FOR ISSUANCE -