1979, 10-25 Permit: 79-6757 Residence PLAN NU BE371 APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 9 7� 7
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE 10 - 1-2_-71
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 2 * * 2 86 0 0
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED * 2 8 6 0 0
SSd
1. E . BLOCK SUBDIVISSIION,Y AVE—
LOT PARCEL NUMBER/S (�-TN 6F Z0 -3'Z-SIJ 7 * 2 8 6 0 0
2. 1 2 F LL.t YS l�vPrrtot4 r E * o,o 0
OWNER PHONE
3, PKNIVEL F.. K I N 535-2W8 6 7 5,6
ADDRESS ZIP Required Set Backs in Feet
lc3a S. /iii.Tf f Aug.- SOoICANE 41`12.02. North 1O Isouth2I7 East 1+4 (west 1-{' 3 1 0—2 5-7 9
CONTRACTOR PHONE Size of Parcel Zone Classification
SAME_ I3c x ZS Ss A-CRIcHLToY Lst4B $' 6A79,
4. ADDRESS ZIP Type Const. Occupancy sppr.niklered
V-iq _ g-3 ❑Yes tENo ❑ Req'd. ;
DESIGNER PHONE Valuation CD Building Area in Sq. Ft.
,. 4.-1906 11 30 -
5' ADDRESS ZIP DWL�Area Basement Area Garage Area Storage
/33Z Gaso 5'9v
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. X
A--"*..
�/ No. Baths No. Floors No.. Rooms Rec. Room
TYPE L�1NEW ❑ ALT. ❑ AD'N. ❑ RPL. El MVE. t r^ NOUS
7. OF ,�-,,,// 0 OTHER Req'd. Recd. Not Req'd.
WORK IirBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL CERTIFICATE
of EXEMPTION // '
DESCRIBE WORK
FEES COLLECTED
8. gssipalcE— 6Ar2-41..c. U►iDF D�'GE R"T'TQ�►�t
JALUATION Source G S • EL CTRIC I ATER SEWER
00 of n
9. Sl��B6X Utilities F A, Sir�C. Single $- —
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included Coo
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building 2.86-Y
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
e diDATE /C —/ _79 SIGNATURE 1 Fi��c c� l( Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: \0 Plan Check
DEPT. REQ'D. RECD. eN6/NEE s, ITh 2-061 L�-r 6�g P
Env.Health VlANI v0, FOR O C /� 6A/2--A-GP
SEPA o
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Planning O lv t4� I• LIC.)
i
g 1� . I Mobile Home C.,p�t
a.
Fire Marshall O lc oN r LE, 12-PaU
Co. Engineer Other (Specify)
r
00
Utilities TOTAL $ 20-tic'
i
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist /fJ f�4 a THISBECOMESA PERMIT. S
DATE Lq �(�� OFFICIAt. �L. i t1 It-6%1 GC —1 1 0 I—.t2 5�_'7.9 6 l 5.7 Z * 2�8 �6 U U O
APPROVED FOR ISS7 ACE / 7 -
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