1979, 11-03 Permit: 79-7615 Mechanical FixturesPLAN 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.
3.
JOB ADDRESS
LOT
BLOC
74 1( — f7I
K SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
ADDRESS
PHONE
9 34
Z CtC, __ 0
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South
East
'West
4.
CONTRACTOR
ADDRESS ,q
N. 3co.3
DESIGNER
itA /11— Coo(
(VI
re -
5. ADDRESS
PHONE
S -'fd
ZIPCV 9.„`
PHONE
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
Eyes ENo ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area f Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6. l >1(
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
TO
Split Entry
Split Level
Rancher
18. ALT. 0 AD'N.
0 PLMB. [FMECH:
O RPL.
❑ M.H.
O MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
c.1-1;11( 1(e. 3 00
ELECTRIC
Gas
Source GAS
of
Utilities
ikobflicti 04iike4r,
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.
DATE
DEPT.
SIGNATURE
1
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/cO M Th7)
DATE f///3
Ude er-
FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
G- 7
DATENO Ut /(kl 1 '7
0 * 1 2.0 0
* 1200
* 1 2.006
B *0.00 n
761,42
11-13-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS, ECOMES A PERMIT.
761,52 *12,00°H