1979, 10-12 Permit: 79-5917 Barn j ti. 5
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PLAN NUMBER R . -
SPOKANE APPLICATION/PERMIT PERMIT NUMBER
COUNTY — BUILDING CODES DEPARTMENT 74—.5.1/7
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE /!J /2 79
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 2 * * 3 2.5 0
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED * 3 2 5 0 n
1. Z. f !a x'°,14//—rids
LOT BLOCK SUBDIVISION PARCEL NU BER/S * 3 2 5 0
2. /`
ez RT 6 ad V -4_a.- 4r Ana B *0.0 0
OWNER PHONE 6T,-V,JC/J ..Z 'TW.. • :fi x+'r` t�(,4 A/.(Y W, LA J
3. l:(.-.,rt-tt'te_, ,4' 9„'4,1-1---.9e7,3. Cid v..Cor . 4-uV. �,D rW 4,410,e10's.H.S. , 5 9 1.6 2
ADDRESS / /'��1! r(/1 / /ZIIPL7 Required Set Backs in Feet • / ] f
.c{(. .�..-,' /Y:L�--Lf---1 _, ! ! .z5(y North Z, / (South 1 East �3-'� (West 'ti !v% 1 0` 1 G` 19
CONTRACTOR 'J/ PHONE Size of Parcel Zone Classification 2 6 4 7 9
4. .�- �� _. )t t/Ct�,�it.Ct
ADT?RESS ZIP Type Const. Occupancy Sprinklered
/h •C alta n— ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
Fgl -
5. ADDRESS ZIP DWL Area 'Basement Area Garage Area I Storage
CHANGE OF USE FROM TO Split Entry e, Split Level Rancher
6. b tet 'a -t:'o
No. Baths No. Floors No. Rooms Rec. Room
TYPE 17.nNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. - /
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH: CIM.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8.
I/2 61-
FEES COLLECTED
VALUATION �j�J Source GAS ELECTRIC WATER SEWER
9t 4,0 O49-21" 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 JO S-79 SIGNATURE &AZ-1-6......-2.,. ..2.2 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
Z, 4:1A:17' SEPACD
oc~
.�
w— c
Planning 0_
Mobile Home cn
Fire Marshall —
Co. Engineer Other (Specify)
Utilities ✓c)
TOTAL $t-R,
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist �y -7 -1 0THIS BECOMES APERMIT. (� �7 7 (�
DATE/ '2'l9FFICIALM/4414'.t.Te_./ 1 0.--1 2'-'7'9 5 7 1. l Z * 3 25,0 d I-,
APPROVED FOR ISSUANCE -
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