1979, 10-03 Permit: 79-5182 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
UMBER
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 3 * * 3 0 5 0
JOB ADDRESS * 3 0.5 0 n
_ ��� LEGAL DESCRIPTION — SEE ATTACHED 3
1. E LOT BLOCK / BoDISION ,6 l./'�" — PARCEL NUMBER/S * 0.5 0 U
2 OWNERPHONE E * 0 0 0 OU
3. L� & 7.1'9.6 i 5 1 & 1 8
jcv_a_.:
ZIP Required Set Backs in Feet
ADDRESS, •••Y.2 /J_ ,..,, i �J 9'9o)4. North 'South East (West 1 0-0 3—7 9
CONTRACTOR KL/�U,.�1'-�, PHONE / ,,/' Size of Parcel Zone Classification 4 7 9
4. ADDsi, d OO5 /C to / A ZIP ���� Type Const. Occupancy SprinOyes ❑Nokl❑ Req'd.
I/��.,�!/J ered9
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.
No. Baths No. Floors No. Rooms Rec. Room
TYPE NEW ❑ ALT. E AD'N. ❑ RPL. ❑ MVE.
7, OFIDOTHER
WORK
El BLD. PLMB. ❑ MECH: D M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. I ,Jr/�� t fr FEES COLLECTED
VALUATION Source GAS EL TRIC 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. 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 �.''S a
performance of co I s7truction. / Plumbing
DATE /d// SIGNATURES' l� � �GG,o/ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health rr
SEPA o
Planning c_.)u_i
o-
Mobile Home v)
Fire Marshall
—
Co. Engineer Other (Specify)
Utilities4/► +
Fes
TOTAL $,•�G�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
/
ID
// a THIS,B COMEzzS A PE(�RMIT. (1
SEPA Checklist IU �7J� / OFFIC (`' �,� �. 'u 0 ,1 / l ,-' 1 U. L o * 3 U.5 Q (L.F-
DATE � T.
, APPROVED FOR ISSUANCE —