1979, 09-17 Permit: 79-4152 CarportPLAN NUMBER
APPLICATION/PERMIT
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
1.
2.
3
JOB ADDRESS
/ ,2 F
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
PHONE
/�Z7-�29z
ZIP
PARCEL NUMBER/S rl_3 ` .2D 3
Required Set Backs in Feet
North (South
East (West
COTRACTOR
PHONE
3zs=a�a�
Size of Parcel
75'x/ '
Zone Classification
L7 7fl.Aft .
ADDRESS
�e3CD2rA a/
ZIP
Type Const.
iG / V
Occupancy
3
Sgrinklered
❑Yes Q.No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
ZIP
J DO
DWL A42j3-
rea I Basement Area
Building Area in Sq. Ft.
6 -aa
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
Jgt AD N.
❑ MECH:
❑ RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. %iZQ�� i-rne aaX
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
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.
DATES—D �� SIGNATURE . / (/ (20--d
DEPT.
SPECIAL APPROVALS
REQ'D. RECD_
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFICIA
APPROVED FOR ISS ANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL 164.'3
Y
PERMIT NUMBER
1'y-1�e l
2/.) /779
02*
*2300
* 23.00
* 23.00
E *0.00
415.18
09-17-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09,-17-7.9 415.22 *23.002
a...1 Of � (Y
c.
7