1979, 07-31 Permit: 79-1314 MH •
FLAN NUMBER - - APPLICATION/PERMIT PERMIT NUMBER `�
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 1
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 7 * * 4 Q 0 0
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED *4 0 0 0in
,. 0 C, CLur , * 4Q00
LOT BLOCK S BDIVISI N PARCEL NUMBER/S
2. / 4 t,irie i✓ 0- --- I'96'79 — /9J7 A Z * 000 8
chil ER / ' •-% PHONE 1 3 t3$
AVDRESS ZIP ) /} Required Set Backs in Feet 3 n
7
J[l ��QS- 7-i-',- f,�, , 4. ,/ 9` /0 t.'' North '3V (South P.;2-.- East 4-� 0'West I y
CONTRACTOR J PH NE Size of Parcel Zon Cass icati n a G 4 7 9.
4. ADDRESSQ{� ) ZIP Type Const. Occupancy Sprinklered
f 9-n-erk-''}. 4 1t'"'1 ! L d l .6 Oyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building.Area ' Sq. Ft.
187
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
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH: XM.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
_ a
DESC WOR
�0 1
FEES COLLECTED
8. rt o OA vi-e-4,t,,e6/iZ2d,
VALUATION Source GAS ELECTRIC WATER SEWER
} of /4- -_
9. / )��C`"ihi Utilities /i / �iC✓ /t Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" prolgsions 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 q— _NSIGNATURES )-1�; ioti Mech.
SPECIAL APPROVALS SPECIA ONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. jaltl:W ¢ =
���f7/' SEPA o
Planning — w
Mobile Home
Fire Marshall
1
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist - THIS B COMES A PE MIT. o ,---,
`
DATE--(
" til OFFIC 47'C' l 7 _. 5 1. 4 7 4 O. 0 0 a
i
APPROV OR ISSUANCE _
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