1979, 11-01 Permit: 79-7166 MH PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT _ 1 (
(C)kp
t NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 7 * * 5 0,G 0
JOB ADDRESS
c� LEGAL DESCRIPTION — SEE ATTACHED * 5 0 0 0 b5
1. BL C/ , BDIVI T 7 1 6 5
-LOT BLOCK SUBDIV SIO , PARCEL NUMBER/S 3,6 3-;L_4 6)� 2
2. /Y -}J' -i--a- r. 4: 11' a,CL°.ry .k.o T,f,:)._ /32-41-<- /k
QW ER PHONE 1 1 -01 -79
3. .,1..1-L- i,t(ti C , , 41 5-,3,2 l: .. PRAiG1 -'T A,0 0 6 LI 7 9.
ADDRESS ZIP Required Set Backs in Feet f
Li 4f?-C / >,[j !.'�wu' _1 ;(. , ,2.1e6-4 • q9-,--1') ,P' North i South East ..i West /�
CONTRAC OR T PHONE Size of Parcel Zone Classifica ion �/
4. v f Q - .i2✓L �t1- ,. .,4446E
A RESS ZIP Type Const. Occupancy Sprinklered
jy �r i ❑Yes ❑No CI Req'd.
DESIGNERI'' PHONE Valuation Building Area in/Sq- Ft.
5. SOD
ADDRESS ZIP DWL Area 'Basement Area Garage Area Storage
/c;0Zij ._ - —
CHANGE OF USE FROM TO Split Entry //,,Spljt Lever Rancher
6. I/t7�-C�_C. e- ig-et---w_i4
TYPE No. Baths No. Floors No- R oms Rec. Room
❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
/ /
7. OF r ❑ OTHER
WORK ❑ BLD. El PLMB.PLMB. ❑ MECH: M.H. ❑ POOL CERTIFICATE Req - Rec'd. Not Req'd.
of EXEMPTION XN
DESCRIB WORK FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
¢ U of
9. ih ?QCi,!)' 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
;ti
DATE I/ei'— -/' % / SIGNATURELf ) Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
-Env- Health
/���/7�
SEPA 6o
Planning �i q ` 2_ — w
I �C 411,1:24: /94/ Mobile Home ���� VD
Fire rshall —
Co. Engineer Other (Specify)
Utilities 00.
TOTAL $ .f-Z)
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT. It`4•L z * n1 n n a
DATE OFFICIAL 1 �t Q 1 ^./ 0i 7 1 l: U U
APPROVED FOR ISSUANCE 1
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