1979, 11-05 Permit: 79-7322 Residence PLAN NUMB/ERR APPLICATION/PERMIT 40 PERMIT NUMBER
' ` �710 SPOKANE COUNTY — BUILDING CODES DEPARTMENT p l� 3 tea-
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE —S.-71
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 2 * * 2 5 6 0 0
JOB ADDRESS _ LEGAL DESCRIPTION - SEE ATTACHED * 2 5 6.G G rn-
L..-3:---T
OT (.,i
LOCK SUBDIVISION PARCEL NUMBER/S . 2..5.--.1/ — q ,53o 7 3 2 1
2. 11 —G5-79
ADDRESS '141ZIP / Required Set Backs in Feet L
I3 `T
/7 4 ?,g/(o° North L[�O 'South 4,.J/ East 73 (West 3
CONTRACTORPHONE Size of Parc (2g'
Zone Classification
4. ADDRESS / 'I l ZIP Type Const. �Cc= cy Sprinklered
w/ N C/\ ❑YeNo ❑ Req'd.
DESIGNER PHONE Valuation Buildi g Area in Sq. Ft.
5' ADDRESS ZIP J i L Area I Basement Area Garage Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE NEI-y ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
2_ _
I
7. OF ❑ OTHER��(BL` ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE
Req'd. Rec'd.
eq'd.
WORK / of EXEMPTION / `
DESCR�BE WC,tRK
8. 6)/(-' -!n— (i22 ,N bL(O, �_ CjGIA FEES COLLECTED
VALUATIONSource GAS ) ` ELECTRIC WATER SEWER
^'3 )er4C9.� (29C) °t. ies''
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 20-60
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. I�
DATE /;--- /� 9 SIGNATURE r/ a._. - Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. iir )"//�/ , Plan Check
Env. Health �0 // "/ ��/9 %! N./ Ca 3. 7-S-- SEPA I—
Planni,g ��/2�r� — �
LI2
S'�l/ 3-7 9
n Mobile Home
Fire Marshall
Co. Engineer Other (Specify)
Utilities 256 6Z)TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT. S2 �� * �,� b
/fes C _ i
DATE OFFICIAL, -�- --41<— 1— 0 :7 9
APPROVED FOR ISSNCE -
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