1979, 12-20 Permit: 79-9354 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 3 * * 6 3,0 0
JOB ADDRESS ck /6 /& ,eeke i LEGAL DESCRIPTION — SEE ATTACHED * 6 3,0 0 175
LOT BLOCK SUBDIVI ION PARCEL NUMBER/S * 6 3.0 0 6
2. B r�
OWNER PHONE * 0 0 0 O
3. 935, 32
ADDRESS ZIP Required Set Backs in Feet
North 'SouthEast (West
T1 2—2 0—7 9
CON ,A L PHONE Size of Parcel Zone Classification
%�C (1...-0“-.61-1 �Cy/075 R 6.4 7 9.
4' jj%//��ADDRESS )) ZIP / Type Const. Occupancy Sprinklered
0/026 r, F'e.rr� 7W , /9,7e ❑Yes ❑No ❑ Req'd.
PaPHONE---�'�/6, Valuation Building Area in Sq. Ft.
5. -
ADD$�55•-�.( 'Roy f iiii/ ZIP„.�z� DWL Area 'Basement Area Garage Area I Storage
CHANGGEr'//O�F USE FROM TO Lf[(�i Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE
ANEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF 0 OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK 0 BLD. APLMB. ❑ MECH. 0 M.H. 0 POOL
of EXEMPTION
DESCRIBE WORK 1-11-•
L
8 ‘7/
/``'•✓ L re FEES COLLECTED .,F
VALUATION 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 ordinances governing this Building
type of work will be complied with whether specified herein or not. Thegr�e1ti of a permit does not presume
to give authorityto violate or cancel the provisions of anyother state or ca VJ re ula . con uction or the
perormance of construc on, g /� Plumbing �'�"�<L —
a/ / y it
y
DATE �� SIGNATURE '"O"stIC - !.�- �---"'
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA r2
Planning _
2
Mobile Home '�
Fire Marshall
Co. Engineer Other(Specify)
Utilities 3 itY"/
TOTAL $ Cf itY/
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS
BECOMESPERMIT.
0
-7'7 5 5, t cL� * 6
5, ! 0 G2 -I
1
DAT OFFICIAL
APPROVED FOR ISSUANCE _