1979, 09-07 Permit: 79-3521 Roof StructureFLAN 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
4.
JOB ADDRESS %
11
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNERI t/� 4"F (p+Lo)
ADDRESS
9rk 7
CONTRACTOR
ADDRESS
DESIGNER
5. ADDRESS
PHONE
PARCEL NUMBER/S _ 170
Required Sett Backs in Feet
North %J (South 4_1
Size of Parcel
,0 )G 12,0
{East 30 lwest
Zone Classification
g , }'14610
ZIP
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area 'Basement Area
Garage Area 1 Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
0 NEW
B• LD.
❑ ALT.
❑ PLMB.
K./AD N.
0 MECH.
❑ RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Req'd.
Not Req'd.
R
8. DESM(J=am Y/T (LJ /t I ' niql, r4 - MV
ALUATION Source GAS ELECTRIC
of
9, �� Utilities
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.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE ,2-G i e-zl/ ,
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DAT
-P �M
�r V WfA ATri1 Fk%
9 OFFICI
APPR
FOR ISSUANCE
FEES COLLECTED
Single
Z3 , OU
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
02* *23.00
* 23.00
* 23.006
A *000 S
299.48
08-28-79
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
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