1979, 10-25 Permit: 79-6670 Residence NUMBER I
0
PLAN NUMBER APPLICATION/PERMIT PERMIT 9e3 SPOKANE COUNTY — BUILDING CODES DEPARTMENT 7 9_ C, 6, 7d
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE /() -- -77
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 2 * * 2. 2 0 0 0
OB A DRESS To LEGAL DESCRIPTION — SEE ATTACHED * 2 2 0.0 0
1. �. � , ` n * 22.0,00
LOT'illBL CK SUBDIVISION I � a� PARCEL NUMBER/S y3 . I ar./1Z j�_ 2,2 J t 0 0 r
2. 3 � Kms ,
OWNERiv 151"1 10c v,I P o i eav b b b.9
'V�V1,� Required Set Backs in Feet yy— 01 -2 5-7 9
3 ADDRESS 0-
-V i I��ii , 1 North (South 3 0 East 3 1 (West 10���� V �+I/ Zoneification b.479.
CONT AC R PHONE SizeQgParcel Cl Cass
(2-6 c I [,6 ,tea./� ,
4. ADDRESSSSZIP Type Const. Occupancy prinklered
Eves ❑No 0 Req'd.
DESIGNER
PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP 106 -0'r ,1) Ba_e �/��a� Garage Area Storage
CHANGE OF USE FROM
TO Split Entry 5 (/,SSplliit Level Rancher
6. No.Baths No. Floors No. Rooms Rec. Room
TYPE 17EW ❑ ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF �'�R ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK "LD' 0 PLMB. 0 MECH: 0 M.H. ❑ POOL of EXEMPTION
DESCRIB WORK FEES COLLECTED
VAL/TION Source GAS E14, TRIC WATER" SEWER
Utiof
lities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included x�p,
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building
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 (.cal I regulating construction or the Plumbing
performance of construction. ` l
DATE W CSC L .1 l SIGNATURE._ ‘ )A
4
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: Plan Check
DEPT. REQ'D. RECD.
Env.Health 4..e.ee
70-7—L3
_ SEPA -
L.-1
o_
Planning
Mobile Home c
Z
Fire Marshall
Other (Specify)
Co. Engineer
Utilities TOTAL $
Zone Clearance WHEN MACHINE VALIDATED IN THIS SPACE,
%0 f THIS BECOMES A PERMIT. •(!
SEPA Checklist 1 0 L 5�J/ 9 6 '7° V ' * 2 2 O.O 0 a I
A q
DATE �` OFFICIAL-�'C-i-�L "Z� 1�Ii,_
APPROVED FOR ISSLARE
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