1979, 11-14 Permit: 79-7773 Addition PLAN NUM ER APPLICATION/PERMITPERMIT NUMBER
-t ' SPOKANE COUNTY — BUILDING CODES DEPARTMENT 6 iq.1113
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 2 * * 6 2.00^'
t
JOB ADDRESS * 6 2.0 0 r)
LEGAL DESCRIPTION — SEE ATTACHED
1.
L T BLOCK SUBDIVISION ^ • PARCEL NUMBER/S j�. ,>_ , / ,r ;, * 6 2.0 0 6
TRA T t
2.// 1.L-rk/ ML. _\i,/ -..--t.. .Ze-.frtJ — �; - E * 0, 0 0
O s•IER PHONE i-C27 7 feA�-/ 7;IL
3. C/.- / .>j.F?--/-rC-- 9::,&,- s /Vl / ui7 / -'-'IsL/ ->c'/.3 6 g 6 2 g
ADDRESSZIP Required Set Backs in Feet
✓! ia � North 'South East 'West 1 0—2 3—7 9
C T TOR / PHONE Size of Parcel Ciassific ior►�
�{// ',r' 8G 6 u✓U g 6 4 7 9.
���� r ��-�,�c�,_.� �1�7-�...� 9 � � til "
4' ADDRESS. ZIP Type Const. Occupancy S rinklered
,� 17
1
i ,. -9. �r 7 Eyes ❑No ❑ Req'd.
DESIGN ,-�ER PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP OWL Area I Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
r � No.Baths No. Floors No. Rooms Rec. Room
TYPE 4a� yNEW ❑ ALT. yx AD'N. ❑ RPL. 0 MVE.
`
7, OF ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd. '
•
WORK N.BLD. El PLMB. ❑ MECH: ❑ M.H. 0 POOL
of EXEMPTION
DESCRI E WORK 1 "
8. ((cud,
/ l FEES COLLECTED
VALUATION Source 3AS ELECTRIC WATER SEWER
t�=� of
9. 4 -1 L9Z/`— Utilities Single $ —
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included O
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 regulatilpg struction or the
performance of construction. // Plumbing
'-- SIGNATURECif
DATE/e --;(7_7..._--: / 7 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: i-,t,nn
DEPT. / REQ'Dp
RECD. I-/iMpjAgaAPPi Iµori Plan Check
Env. Health !/// .3. /C,..,. tG��f^N``A..`- ti
ffr ,,��// 'Y
c`� �IripvF^ SEPA
Planning 11 , r Lu
Lu
Mobile Home cn
Fire Marshall
Co. Engineer Other(Specify)
Utilities Z%'02- O
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
SEPA Checklist Pi-A*/J oil
DATE (0(0-25-741(0-25-741 OFFICIAL-.1 y"/ �/� 1 .l —`l 4 =7 9 7 % 7. 3 z * 6 2, 0.0 d I-
1"..eJfl1u./tr��
APPROVED FOR ISSUANCE
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