1979, 09-25 Permit: 79-4669 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
JOB ADDRESS
tl�
L(Si' �CdCK�
SUBDIVISION
LEGAL DF4SCRIPTION - SEE ATTACHED
OWNER
3 14 . -i cu p
ADDRESS
Ctrr/
CORACTOR / I a n
C VL -1
4.
PHONE
ZI P
PHONE
PARCEL NUMBER/S
Required Set Backs in Feet
North
South East
West
Size of Parcel Zone Classification
4DD)R ESS
N 124 A h
DESIGNER
5' ADDRESS
6.
CHANGE OF USE FROM
TYPE
7. OF
WORK
0 NEW
0 BLD.
DESCRIBE WORK
VALUATION
9.
T
ZIP
ctZ ( 1
PHONE
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes No 0 Req'd.
Valuation Building Area in Sq. Ft.
DWL Area 1 Basement Area
151ALT.
❑ PLMB.
❑ AD'N.
MECH:
❑ RPL.
El M.H.
❑ MVE.
❑ POOL
0 OTHER
Split Entry
Garage Area
Split Level
Storage
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
,1 i. im (( 01-)(.1
Source GAS ELECTRIC WATER
of
Utilities
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 LI C SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
g
DATE
PERMIT NUMBER
7/.--4&6g
q—��-7
04* • *9.00
*9.00
*9.006
E *0.00 n
16682
09-25-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COM �
A EAtMIT.
09-.2 '-J; 6.96
*9.0 0
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