1979, 08-07 Permit: 79-1635 Renew Permit L5959PLAN 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 ADDRES
1 616,
/�tt,
`i"4
LEGAL DESCRIPTION — SEE ATTACHED
1. I�• 7
LOT
I BLOCK
SUBDIVISION
PARCEL NUMBER/S
2
Uz or N , J C20
OWNER
PHONE
ii nn
AD{{D��RES I /
f
111
ZIP
Required Set Backs in Fe t
r" h h 1
A'
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zon Classification
4. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
TYPE �/ No. Baths No. Floors No. Rooms Rec. Room
❑ NEW ❑ ALT. Lif AD'N. ❑ RPL. ❑ MVE.
7. OF�,/ 1:1OTHER
WORK LJ BLD. ❑ PLMB. ❑ MECH: ❑ M. H. ❑ POOL CERTIFICATE Req'd. I Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. I loN I i -'I f
V_ ALUATION Source GAS ELE, Tj IC WATER SEWER
'r�' O of J/ �y
9, O Utilities
— -#
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. i-
DATE 7 — SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
hA� rry 7
DATE /nOFFIA-K—
PERMIT
n
/ nn
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
NUMBER
DATE
02* *43,00
*43.00 N
*43.0010
A *0.00 0
1 63.4
08-07-79
;s 6479.
SEPA F
c
— LL
Q
Mobile Home v
G
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-07-79 163,52
*43.0;0a -[J-