HomeMy WebLinkAbout1979, 09-19 Permit: 79-4291 Insert PLAN NUMBER APPLICATION/PERMIT ......„, PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT /`' 4 2 l
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
* 7.00
JOB ADDRESS 02 *
1. (0 91 : 6-r LEGAL !ASCRIPTION — SEE ATTACHED * 7,0 0 In
LOT BLOCK SU DIVISION PARCEL NUMBER/S *7 O 0
2.
OWNER fit, . i� �� PONE A * 000 0
3. [1, � �r ��`r!�/v , -r-r AG-554-6_
,l, Required Set Backs in Feet 4 2 9.0 2
ADDRESS 1'62 _ „ v
1 '2cJGj North 'SouthEast West
0 91 9—'�9
CONTRACTOR PHONE Size of Parcel Zone Classification
4. 146 2 6.4 7 9,
ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER 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.
TYPE ,� No. Baths No. Floors No. Rooms Rec. Room
❑ NEW ❑ ALT. LJ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER -
WORK BLD. ❑ PLMB. ❑ MECH: D M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8 .Z.- -K--e? 04 ,_s` I rig, -
,n r', Mv o I / FEES COLLECTED
VALUATION Source GAS ELFJrF/TRIC W TER SEWER
of
9. Utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included c .•7, (30
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 regulatins �ction or the
performance of constru tion.7)
. P tubi
r, ng
DATE SIGNATUR7 -14Allir / Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
cc
SEPA I�—
Planning _ rL
d
Mobile Home C.,
Fire Marshall
Co. Engineer Other (Specify) rrryyy
Utilities •/
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA ChecklistTHIS BECOMES A PERMIT.
DATE •/ K� -7,OF -VIIIIII0.
� ' '0 9'�—'19 i-7'9 4 2 9. 1 z * 7. 0.u 0 i'
1/ A"''7!""I FOR ISSUANCE _