1979, 12-12 Permit: 79-9002 Insert PLAN NUMBER APPLICATION/PERMIT ® PERMIT NUMBER , I
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
77_ 9°P-
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE --11` 71
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
04 * * 7.00
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED * 7,0 0
1. -7/., /ice,' �1��� .l'C.}2t�
LO BLOCK SUBDIVISION PARCEL NUMBER/S * 7,O O U
2.
O. PHONE E * 0,0 0 ;�
3. ,�,-4. �: ,..r . 1..0.2.9902, q'Zik— i'%61 9
ADDRESS ZIP Required Set Backs in Feet 0 0. 1 2
14 6,/,....5" 'J/.G4 /r1�, X14 North (South East (West 1 2— 1 2-7 9
C TRACTOR PHONE Size of Parcel Zone Classification
4. d(),—.110., 2 6.479.
ADD ESS ZIP Type Const. Occupancy Sprinklered
z0h0//�,_ ❑Yes ❑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. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHERReq'd. Recd. Not Req'd.
WORK ❑ BLD. 1=1 PLMB. cK MECH: ❑ M.H. ❑ POOL CERTIFICATE
of EXEMPTION
DESCRIBE WORK 4 FEES COLLECTED
VALUATION Sou e 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
performance of construction. Plumbing
DATE /o2--//-2' 79 SIGNATURE__ t^14-4 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
x
SEPA 0
e—
uL,
Planning - w
2
Mobile Home `n
Fire Marshall
Co. Engineer Other (Specify)
uG
Utilities TOTAL $ 7�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist /,_/.2.., 7 q THIS BECOMES A PERMIT.
-, Q ^ 90,2 ` * 7, 95 ° ;=..
DATE OFFICIAI �� 3E: 1 ii'/y 1-7 4
✓l/___ L _� .
APPROVED FOR ISSUANCE _