1979, 09-28 Permit: 79-4951 Mechaical Fixtures4
1
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1.
2.
JOB A DRESS J�
5 -to E.- 1 -
LOT I BLOCK SUBDIVISION
P-oK-)e\ 13l -
LEGAL DESCRIPTION — SEE ATTACHED
3.
OWNER
Ott IV R -G E
ADDRESS
Com- -i�r tYl
PHONE
ms s -f73`)
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North !South East 'West
CONTRACTOR �^
4. ( UAL. 4TC� GLtifi
ADDRE
Ic> A,vA PoeAI.r
DESIGNER
5' ADDRESS
PHONE
9.?S-03/6D
Size of Parcel I Zone Classification
ZIP
9 ‹a -J
Type Const.
Occupancy
Sprinklered
Eyes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area r Garage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Split Entry
Split Level
Rancher
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DE CRIBE WORK
8. V eky - 67 .•0•5 6. /iI T 14C�`r&
VALUATION
9.
Source
of
Utilities
GAS
xxx
ELECTRIC
WATER
SEWER
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
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. �f /
DATE 9—.016 --ti
/ 9 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE! - 7' OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Cf,
Single $"
Building
Plumbing
Mech. fry
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $15_
PERMIT NUMBER
DATE
04* *15.00
* 1 5.00 N
*15006
E *0,00
4950
09-28-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COM A PERMIT.
0_12 —79 4.95.12 *15,0021