1979, 11-14 Permit: 79-7765 Mechanical Fixture PLAN NUMBER APPLICATION/PERMITPERMIT NUMBER I
f�/
SPOKANE COUNTY — BUILDING CODES DEPARTMENT "� 77 — 7'7
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE II—1 a 1)
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 4 * * 1 2 0 0
JOB ADDRESS * 1 2•V U
k) 2_31. 0111) L3cO . -vJ"J' LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S B * 1 2 0 0
Y
2. * 0,00 0
3. OWNER (AI
3. W
, ` W ST(Li(76 • IE� 776.4
ADDRESS ZIP Required Set Backs in Feet
3C. e North 'South East 'West 1 1 - 1 4-7 9
CONTRACT PHONE Size of Parcel Zone Classification 6.4 7 9,
-0/1 /66r
4' ADDRESS /� ZIP Type Const. Occupancy Sprinklered
• 0
v &)c)S t TI.A ,I- Oyes ❑No ❑ Req'd.
DESIGNER VW \ ►V 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. b1L 6
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW I:- 1-. ❑ AD'N. El RPL. ❑ MVE.
7, OF �/ CI OTHER CERTIFICATE
WORK
CI BLD. ❑ PLMB. Ir ' CH: ❑ M.H. ❑ POOL Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK � S{ (
8. N ( i )j�0 �j,iVile I c� 10 t nwek/ FEES COLLECTED
VALUATION Source /ll GAS �(J ELECTRIC WATERVYI� 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 I. al law regulating construc ion or the
performance of construction. 1 0 Plumbing
1 O
DATE I [—, -'ZCi SIGNATURE_ / Mech. 1 O
SPECIAL APPROVALS SPECIAL CONDITI(t•:
DEPT. REQ'D. REC'D. Plan Check
Env. Health
SEPA `-3
CJ
to
Planning — '1_
Mobile Home
Fire Marshall
Co. Engineer Other(Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist //At—
�/ O1111* THISBECOMES
,BECOMES A PERMIT.
DATE J
//f7" 11 . 14 -79 ( 6, 5 ._ * 12, 00 I
,..te, a FOR ISSUANCE