1979, 10-08 Permit: 79-5511 MHer
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: C
MPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
OT
BLOCK
SUBDIVISION
4' ADDRESS
OWNER
qG eri
ADDf3.ESS 175 --r Li1 AC6'.
CONTRACTOR, /
�v t
PHONE
ARCEL NUMB=R
0 751 — Or riVcrL FLAVA
‘1;
ZIP
P�O1 a
54-4211
ZIP
Required Set Backs in Fee
North !South
East (West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
BuildinArea in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
10
Garage Arda
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
tiNEW ❑ ALT.
❑ PLMB.
❑ BLD.
❑ AD N. ❑,PL. ❑ NAVE.
❑ MECH. ld M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBEV)4ORK
8.°14
1 L -
V Lw��ATION
9. C9
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
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
performance of construction.
Source
of
Utilities
GAS
ELECyF21C
WATER
SEWER
DATE / � . I SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
g-gG 7// 2
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
Feql95465.- hi
Go NYPq69'10 ��I2•
`rwt,rki\lr NO- Ii<rrue. ro railoOtt-
raivIrr r[fIN OH' Imo)
DATE/0`8-'71oFFICIAL�/r"(J7' ""'a fijilitrOf
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
�s
$ 5-0
V.11 PERMIT NUMBER 7g/
['
DATE
*5000
*5000
*50.00
B *000
551.02
10-08-79
6479.
N r
_ w
CL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 0-0 8 -7 9
GG'
551,1A
*50,00°'IJ