1979, 09-12 Permit: 79-3883 Plumbing Fixtures .AN NUMBER APPLICATION/PERMIT -
PERMIT NUMBER l
SPOKANE COUNTY — BUILDING CODES DEPARTMENT P38`"3
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
03 * * 45.50
JOB ADDRESS
1. -err /k. e( r � Dt.ra LEGAL DESCRIPTION - SEE ATTACHED * 4 5 5 0 n
, U-�-� e
LOT BLOCK SUB IVISION PARCEL NUMBER/S * 4 5,5 0 1,
2. A
OW ER PHONE * O.0 0 O
3. gake �A5-'4,,c1 ® 3882
ADD ,11 '� �' '• + ��,ZIP Required Set Backs in Feet
CONTRALTO i PHONE S'�orth ze of Parcel (South EZone Classificatlionst 0 9- 1 2-7 9
/ ,2.I.,-.2.44'‘, 6 4 7 9,
4' A �`'R�ESS r► i `� // ZIP C��) 7 Type Const. Occupancy Sprinklered
..I'c 3Vo : + V'�LLtGN, 9 W.3 7 ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
rJ. ADDRESS ZIP DWL Area I Basement Area Garage Area I Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No.Baths No. Floors No. Rooms Rec. Room
TYPEW ,❑, ALT./ I=1 AD'N. 0 RPL. ❑ MVE.
7. OF ❑ OTHER -
WORK 0 'ILD. [4.-F.'PLMB. ❑ MECH: ❑ M.H. 11POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8.
7 tis 9.-f:
_7L FEES COLLECTED
VALUATION Source 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 ,�`..n
performance of construction. �/�I
DATE ✓� _ SIGNATURE 2 Vete-161-1
Plumbing /`^'
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health
SEPA J
Planning — w
1
Mobile Home C/D
Fire Marshall z
Co. Engineer Other (Specify)
Utilities /`'�`S
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist _. THIS BECOMES A PERMIT.
�// PL."- , 09`-.12 9 :, , _
DATE �� / 7,OFFIC ► —? J U u J ,._, * 4
5'5.0 O _
CCC APPROVED IR ISSUANCE 1 u a H