1979, 07-26 Permit: 79-1083 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.-7
OWNER
BLOCK
SU6DV1SION
iI17kf At-1eH
PARCEL NUMBER/5
2-4-5-51 —6; C'C'
3 Rot.'A.z,D p C-1 RAI/FIS
ADDRESS
5-82.0 E - ¥ m!4- SPAc. /4- SpoicANE
4.
CONTRACTOR
_`;J4 M F
ADDRESS
PHONE
53`f -�l(P5
ZI P
Cfq o6
PHONE
Required Set
Backs in Feet
North .S 'South 33 ,
L[East Lt 3 (West 5—
ZIP
Size of Parcel Z� Classifica; i n
1l
Sprinklered
❑Yes ❑No ❑ Req'd.
Type Const.
V -N
Occupancy
DESIGNER
5' ADDRESS
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
4 /2., (3,°-%c
WL Area Basement Area
ti
7`7,2—
ZIP
7?
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
M6811 -E.. HoMr
TYPE
7, OF
WORK
Yd NEW ❑ ALT. ❑ AD'N.❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. IES M.H, ❑ POOL
❑ OTHER
No. Baths
7
No. Floors
No. Rooms
5-
CERTIFICATE
of EXEMPTION
Req'd.
Recd
Rec. Room
N04E
Not Req'd.
DESCRIBE WORK
s. Mob/ LE 1 fDM/Sep
, S g /DgNcE
VALUATION Source SEWER
of
g, utilities
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
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 stateror local law regulatinco/ ruction or the
performance, of construction.
GAS
ELECTRIC
FR
WATER
SEpnC
DATE
DEPT.
SIGNATU
E
C
SPECIAL APPROVALS
REQ'D.
RECD.
Env. Health
Alarming
5 - (.; A /?�'jV t
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
6N MAP
//w 60'
1 DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home *X
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
79--IO�`�✓
07* *it6866
A *49.@@
10812
07-26-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-26-79 108.32 *40.00
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