1979, 11-15 Permit: 79-7863 Residence PLAN NUMBER 1 76-3
'mss PERMIT NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT 7qU BER
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE /l—A5—< q
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 2 * * 2 ;.;,
JOB ADDRESS DESCRIPTION — SEE ATTACHED 4,-
1. i.:5—,73d 7 9 TN _4
LOT BLOCK SUBDIVISION �,j�� PARCEL NUMBER/S p7-iv. ��3,�^i/7/ .�„�fR * (- `
2. . i4)—tek- ; Cal`�' r / F:1 _`- �:
NER �s PHONE
3. tilty— - .ate a. • ....g6 a) 7861
ADDRESS /��y�l��,�ynn� ZIP/ Required Set Backs in Feet /
/3 7 . J -O- - ✓f �- 9 7-Z/6 North 71 / (South / East ^/'/ (West td 1 1 - 1 4 w.
CRACTOR / PHONE Size of Parcel Zo a Classification `
4' ADD ESS ZIP Type Const. Occupancy rinklered
,41//...A./-i__,,' ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area i7Sq. Ft.
gee)
5. ADDRESS ZIP DWL Are/ Basement Area Garage Area ' Storage
god & -- - _
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. X
No.Baths No. Floors No. Rooms Rec. Room
TYPE a< NE ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF 0 OTHER CERTIFICATE /
Req'd. Recd. Not Req'd.
WORK ❑ BLP. ❑ PLMB. ❑ MECH: 0 M.H. 0 POOL
of EXEMPTION >(.
DE CRIBE W(r)RK
8. �/_ FEES COLLECTED
.�J l .c it f,'sZ_-
JALUATION �!, Source GAS ELECTRIC WATER SEWER
.4/� of
9. �/ 0 Utilities Single $ —
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included �)U
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building -1)L''
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 stat& or.focal I.? regulating const tion or the Plumbing
performance of construction.5 J!
DATE /f—, — 79 SIGNATURE W lk `7 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. ////////�� � /�JyyD-1 Plan Check
Env.Health
A �,ifir.®�u '-' � "_ ce T^___6e, /7,/5/77 SEPA o
Planning - w
a
Mobile Home cr)
Fire Marshall z
Co. Engineer Other (Specify)
Utilities 60TOTAL $ `2'46
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ,'!� 79 THIS BECOMES A PERMIT. _
/ /(�'� y// _ )
DATE O F F I C I A 1442.b zial �G_____ .t 1'-- 5 - ('(i i 6. 5 ' * l 6: ,I
APPROVED FOR ISSUANCE 1 -
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