1979, 09-20 Permit: 79-4342 Residence PLAN NU ER APPLICATION/PERMIT PERMIT NUMBER
//////C//JJ�Z SPOKANE COUNTY — BUILDING CODES DEPARTMENT 17— 1,/`" 51Z
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE y-42-e) -7�
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESSp 0 2 * * 21 1,0 0
1. '7.5zOa e yzlcLam. LEGAL DESCRIPTION — SEE ATTACHED
th-
LOT BLOCK SUBDIVISION PARCEL NUMBER/S * 21 1.O O
2. �` e5 W 2 .Pu i' 7I IL ADD It(°A _ 7 * 21 1.00
OWNER PHONE .; 'i 5 -3 4 — O5 Of 4E21W:4a
3. vii 1 k t- 'TEgi-t A6tz-- 4Y7 0•3 e2. E *0,0 0
ADDRESS ZIP Required Set Backs in Feet 4 3 4/, 1 2
Nt.. 2'623 Likeek' 99aC7 3
North b 'South 710 -0[East IWest 1i 9 n
CONTRACTOR PHONE Size of Parcel Zone Classification 0 7 9
-2 0-
m1cHAEL_ 3f1rneS CdniS'f �IA4 lot,y 140 y 5 ' �-6e-lc /5u13U iS 6479.
4'
ADDRESS ZIPType Const. Occupancy Sprinklered
^
(04114 5'i Ai 1 O /U 9 Zr e, .v4 E3 CI Yes ENo ❑ Req'd.
DESIGNER �_ PHO ValpionT, % Building Area Sq.��t ;
5. ADDRESS ZIP /yDWCCLL//oe�)f,Area .NBase ej Garage Area Storage _
TIL `4, of--i/(�) —
CHANGE OF USE FROM TO Split Entry plit evel Rancher
6. --- -
FR:4's
No. Baths No. Fs No. Rooms Rec. Room
TYPE 2/NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. L y.� 1�
7. OF _, ❑ OTHER 1 - { IJ/v/
WORK BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICAT Req d. Rec'd. Not Req'd.
of EXEMPTION X
DESCRIBE 8iORK
8. 14.E ) 5ihlbL-E F:NyhhLY k'ESiDEACE. FEES COLLECTED
VALUATION Source GAS ELECTRIC /��yTEeWATER SEWER
9. 42, 95 of ---utilities �a33 WR 'IISTEON SEPI IC' Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions includedk) —
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building ,0/f/
type of work will be complied with whether specified herein or not. The granting,of a permit does not ume
to give authority to violate or cancel the provisions of any other state or ocpl la ,re Ulating constr on or the
performance of construction. j t Plumbing
DATE
<:,'—' 7— 7 f SIGNATURE? I J teV
4
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health �/
0(1_,At 0,-/._ � �
I l � ✓i SEPA cc
I—
Planning W
— 2
Mobile Home ul
Fire Marshall
Co. Engineer Other (Specify)
Utilities (�
TOTAL $ cZ/l
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ///
J
�t� _ BECOMES A PERMIT.
/ THIS ,1
DATE 1 OFFICIANL: �� 0 9--..,2 [1 r_7 (1 4 3 4, 2 2 *2 1�.L 0 0 2 r2
APPROVED FOR ISSIhCE U 7
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