1979, 10-04 Permit: P79-5364 Plumbing FixturesPLAN 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 ADDRESS
�la�LOT BLOCK UBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
2.
3. Obl�IER
k&So4)
,i3ox %gO
COI1TRACTOR
4. h. l ee " Y L e€ - Lk t
AL}D.RESS j 5✓1
SIV/ � / zY' ' ! .�
PARCEL NUMBER/S
PHONE
ZI P
Required Set Backs in Feet
North 'South East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
❑ BLD.
O ALT.
❑ PLMB.
O AD N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
/3 3l)- e3
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 gr ting of a permi does not presume
to give authority to violate or cancel the provisions of any other stat •r lo law regulating ' ..nstruction or the
performance . f con ruction. / /
DATE
DEPT.
9
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL COND IONS:
DATE OFFICIAL
FEES COLLECTED
Single $
Building (�%
Plumbing (3�4S`)
Mech.
Plan Check
SEPA
Mobile Home
300 ��
Other (Specify)
TOTAL
$3 D
p
PERMIT NUMBER
DATE //2 "O— 79
03* *35.50
*3550 17)
*35.506'
E *000 n
53632
10-05-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-05'-79 53'6.45 *35,50 2 1