1979, 08-13 Permit: 79-2082 MH PLAN NUMBER APPLICATION/PERMIT —
PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 07 * * 54.00
1 0'B ADDRESS
l/CESS *I-
f II Kw LEGAL DESCRIPTION - SEE ATTACHED *54,00 V
LOTI BL CK_ SUBDIVISION PARCEL NUMBER/S * 54.006
2. v krrL6VI0A1kCimI? 1-5 - 19,9
A *Q00
OWNER PHONE
/11 �� 28' 017 208. 1 2
3. �Ip Required Set Backs in Feet p �7
AD R SS� , 08- 1 .� ! 9
/2. //�� Hord[o North ' 0 'South East (West 10
�l?' I ►�'I II
CONT ACTOR PHONE Size of Parcel Zoneifica ion 6479.
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building/A^ra in Sq. Ft.
VCf/
5' ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. No.Baths No. Floors No. Rooms Rec. Room
TYPE i NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF / ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. 0 MECH: Err/I.H.M.H. ❑ POOL
of EXEMPTION
DESCRIISIE WORK FEES COLLECTED
8. N1' IVI31 I.6. ( x 701 —t—(7 x
VAQLUAT/IIO/N Source GA ELECTRIC WATER
p�p SEW R
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
Plumbing
performance of construction.
ig -5'`7� SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: Plan Check
DEPT. REQ'D. RECD.
r
Env.Health ^�
C i �}-vr �c5 h/ 7 d SEPA r.--
Planning 54.,
r,_
Mobile Home �.)
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
TOTAL
Zone Clearance ,-
WHEN MACHINE VALIDATED IN THIS SPACE,
/,:,_ t--)
THIS BQQECOMES A PERMIT. pp
SEPA Checklist /� �--7 0 U — l 5 —7 9 L Iii rJ, C * 5 4, 0 0 a .-
DATE Y'1//fJ l OFFIC •
APPRO €13 fiR ISSUANCE -
N
II
SI
11 .
(02-"&i7i)6 V1°41 al 10H
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