1979, 10-05 Permit: 79-5405 Plumbing Fixtures PLAN NUMBER
APPLICATION/PERMIT PERMIT NUMBERI
I` SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 3 * * 2 5 5 0
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED * 2 5.5 0 N
LOT BLOCK SU DIVISION PARCEL NUMBER/S * 2 5 5 0 v
2. * Q00 0
3. OWNER
14I&IOici 156er0N 14- 540.4
ADDR SS, r�i� N� ZIP Required Set Backs in Feet
[P� 9-fZ North 'South East (West 1 0—0 5—7 9
CO NTR iTOR I PHONE Size of Parcel Zone Classification 4 7 9
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
Oyes ❑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 KNEW ❑ ALT. ❑ AD'N. ❑ RPL. CI MVE.
7. OF � ❑ OTHER -
WORK ❑ BLD. VI PLMB. 0 MECH: 0 M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE MARK
8 - M mI6 '~)� FEES COLLECTED
VALUAT ON 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 451 50
performance of construction. Plumbing
DATE 5-2e,�9 SIGNATURE _ sil,of-
:74---,-.-4--..-----/
Mech.
SPECIAL APPROVALS SPECIAL COND ANS:
DEPT. REQ'D. REC'D. Plan Check
Env.He31th
4rr
SEPA o
Planni g — iU
0
Fire Marshall Mobile Home Z
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
` THIS BECOMES A PERMIT.
SEPA Checklist "� � (1 -
DATE I° /��OFFI •� �. ,�� �71 U - 5 i I 7 , H� 1', , ? * 2 5. 5 �
APPRa1�l� FOR ISSUANCE