1979, 11-02 Permit: 79-7174 Piping (PLAN NUMBER APPLICATION/PERMIT ^ PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT /f� 7, 7/
a NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 a * * 6 0 0
JOB ADDRESS
1. x110, �i 4--m LEGAL DESCRIPTION — SEE ATTACHED * 6,0 0
LOT BLO K SUBDIVI ION PARCEL NUMBER/S * 6 0 0 Y
2. F * r�
3.
OWNER
klkPHONE
I �AJ� � M � ' 9_ 71738 O.CG
"
ADpyS 14 ZIP Required Set Backs in Feet
Sd /�� North 'South East IWest 1 0-0 2-7 9
CONTRA
TOt P ONE /� Size of Parcel Zone Classification
Y ''S1'� 6 d621, —7007 7V 07 g 6.4 7 9.
4. ADDSs 0 to
0 0 TV
Type Const. Occupancy Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I 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 fe<EW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK I=1BLD. ❑ PLMB. MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd. ,.
of EXEMPTION
8
DESCRIBE o rt K �q r FEES COLLECTED
i`�`[1 � � �ISN
VALUATION Source GAS ELECTRIC WATER SEWER r'
of
9. 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
DATE /F /4.---/.2
SIGNATU C � �
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA `.D
I—
Planning _.. LU
1
Mobile Home
Fire Marshall .
Co. Engineer Other(Specify)
•
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist t THIS B COP A MIT.
!/l ,�
DATE OF' CIAL
APP':. ; IR ISSUANCE -