1979, 09-21 Permit: 79-4448 AdditionPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1.
2.
3.
4.
JOB ADDRESS
50'2`O W°g941A1Ki 1711.\/
LOT BL'OCK SUBDIVISION
ryv(r
PHONE`
OTZVINI
ADESS5S24-2 K100
0
N P2I\�
CONTRACTOR
(ff;H`4.‘4;a--)
ADT
SS I j -')r O r ►\I
lL�
DESIGNER
5' ADDRESS
PHONE
_6I0
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S j - 1 13,7
Required Set Backs in Feet
North 2� 'South
East (West
Size of Parcel Zon Classificati n
Type Const.
Occupancy
Sprin lered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area
33�
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW ❑ ALT. L✓J AD'N. ❑ RPL. ❑ MVE.
<LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8. OVNI L -7f 1S121\11 DESCRIBE WORK 1 I Gf j�I /� jam/ i�� I I
TOki t\le, VICl/ �Y R(I(t'� E
VALUATIONGAS SE
s. 91 000.
1 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 st•r local law regulating construction or the
performance of construction.
IOW .Pikaur
Source
of
Utilities
DATE
/ 7—%9
SIGNATU
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
.s6/C-n-c) /f/7 y
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
rC .0i,i d €
r id\r`l
o011', c7o-La- RC -6;3279 Kc
DAT Eq ''7 90FFICIAS
APPROVED FOR FOR ISSUANCE
FEES COLLECTED
Single S
Building -741-`(2°
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
DATE
$ 7�
-410
PERMIT N&MBER
7 q .<74'i jLg
02* *74,00
*7400
*74006
E *000 n
44472
09-21-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-21-79 4448
*7400
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