1979, 10-01 Permit: 79-5054 Residence PERMIT NUMBER
[PLAN NUMBER APPLICATION/PERMIT I
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SPOKANE COUNTY — BUILDING CODES DEPARTMENT ��- '� ��
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE sPrtd97`1
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS 0 2 * *2 1 1.0 0
LEGAL DESCRIPTION - SEE ATTACHED
1. N r16 yr M A�TF_R_ ROAD * 21 1,0 0 N
LOT BLOCK SUBDIVISI N PARCEL NUMBER/S/6,54 Z _..o7 77 X
2 y- .ii -y * 21 1,006
OWNER its-(0.6c y"FZ, PHONED T-fe�tL! .A 5l'�ORT P.>�AT 1 ge)z, E *0 0 0 6
3. H I(GJN 130-1-T13 IA cows-TKUc-rlonl 524-15-B: 5
ADDRESS ZIP Required Set Backs in Feet 0 5.3$
0X jL7 I pn1��}Alq", 79214. North Tge/3'Isouth 7 r East 4.3.i63 'West 30 ' 1 0 41 -7 9
CONTRACTOR PHONE Size of Parcel Zone Classification
SWF_. 7s'x 97 A►moy 2 6.4 7 9,
4' ADDRESS ZIP Type Const. Occupancy Sprinkleredri
J— R 3 Dyes ..1 .o ❑ Req'd. 'e
DESIGNER PHONE Valuation Building Area in Sq. Ft.
ADDRESS ZIP DWL AreaBasement Area Garage Area Storage
970 I SR$ o i •--
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. -- 3-L
TYPE
111---- No. Baths No. Floors No. Rooms Rec. Room
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE, i
I 5 N0. �,
7. OF 111OTHER 1
WORK L4I BLD. CIPLMB. I=1MECH: CIM.H. CIPOOL CERTIFICATE Req'd. Recd. Not Req'd.
of EXEMPTION Y
DESCRIBE WORK
FEES COLLECTED
8.
IZF /pEN cE_ No DF_c.K 5 vf{. E ARA& Yr
VALUATION Source GAS ELECTRIC WATER SEWER
9• 3'7L OOO9TCX Utilities B,g 'S TI c-
F Single $ —
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
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on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building SZ1/icc
type of work will be complied with whether specified herein or not. The granting of a pe it does not presume
to give authority to violate or cancel the provisions of any other state or local law regul. ing constr. tio' .+' he
performance of or• ruction. Plumbing
DATE SIGNATURE 4.�A �� -i A.A. DIP'
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: '
DEPT, REQ'D. REC'D. t`/W n 53' NP Plan Check P
Env.Health ff -A'1`iK;�(C=so` '
�C ' �//C� 7Ci ON NAM' �P SEPA I-
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Planning f w
0
cn
Mobile Home
.Il z
Co. Engineer Other (Specify) - - - - - - -- --- - --- - -
Utilities
TOTAL $ .�1P1-°°)C
Zone Clearance
/1 WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS COM A MIT.
DATE/4/ OFFICIAL _.-./ //ir .. - .. ��D 5.-4 Z *'21 LOU a �
APPROVED FOR ISS NCE 1
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