1979, 12-26 Permit: 79-9450 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT ` } / L�
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE12 /-
/9 _ 71
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS /� "rI- LEGAL4DESCRIPTION - SEE ATTACHED 0 3 * * 8 0 0
1. , / If r-"'
'` * 8,t� 0
LOT L K SUBDIVISION PARCEL NUMBER/S
2. * x006
OWNER P ONE
(�j/ AA 0 irl ¢4FD
7f B * 0,0 C
3. ADD /R • ZIPRequired Set Backs in Feet 9 44.9 2
/ 9"7.2-16`/6 North 'South East (West
CONTRACTOR PH NE Size of Parcel Zone Classification 1 2-2 6-7 9
.7 y3 F A,r /Ley V St'S -stir . 'fZ'-Xl1L 6 4 7 9,
4' ADDRESSjZI�P]f { 7 Type Const. Occupancy Sprinklered
/160 7 E - / I✓e_^c [ ! 2C6 Eves ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
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 WALT. ❑ AD'N. 0 RPL. ❑ MVE.
7, OF 0 OTHER
WORK 0 BLD. xi,PLMB. ❑ MECH. ❑ M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE ViORK
8 I A�b,i ci T FEES COLLECTED
VALUATION V Source GAS ELECTRIC WATER SEWER
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 ordin.•o- •.,- ,'•, this Building
type of work will be complied with whether specified herein or not. The granting • a per it does not pres e
to give authority to violate or cancel the provisions of any other state or lo.:l la regula .4; construct'•• z e .<7.400
performance of construction. Plumbing
�
DATE 1Z_ L 77 SIGNAT -E /. 1/.: ._4' I/_� Mech.
i
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
��ff
Env. Health "" t /� 16i._) y-S`C`/
........ c...0
SEPA
Planning —
Mobile Home
Fire Marshall %fJ� -
Co. Engineer Other (Specify) -r i� 4
Utilities J� %}
TOTAL $ 1 �/(/
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ` THI$BECOMS AYE iRMIT.
DATE/Y/6 OF54-et ''' -'*"---"--3''' -'*"---"--31 C 6 7 4 53
i -
APPROVE-6 FOR ISSUANCE —