1979, 08-07 Permit: 79-1665 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER I
—3 D 1 SPOKANE COUNTY — BUILDING CODES DEPARTMENT J-79 &
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE JtiLy 7_7, "i7?
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 2 *' *50,00
JOB ADDRESS *5 0.0 0 N
1. a I I Z® 1' ICo /4 AVP LEGAL DESCRIPTION — SEE ATTACHED * 5 Q 0 0
LOT BLOCK UBDIVISION PARCEL NUMBER/S n� V J f J OF. 2.8542 - /803
2. Cc 2. KOKOMO TOWN5rrE., . " A * Q00 n
OWNER PHONE
3. ED. FN GEL St.11LDE� ( -G133 16642
ADDRESS ZIP Required Set Backslin Feet 0 8 07-7 9
5215 s coNKL1N kola ciREENActe�s ? 016 North `South East West
CONTRACTOR PHONE Size of Parcel ' Zone Classification R 6 47 9,
4.
SAM'S _ 50 4X /30 yR(GUL—ruRAL SUR
ADDRESS ZIP Type Const. Occupancy Sprinklered
ll-K g-3 ❑Yes ONo ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
if7 500-cx 9G2. —
5. ADDRESS ZIP DWL Area Basement Area Garage Area Storage
85-o I `d1, Nome. NONE
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6. X
,_3..--•*"
,� No. Baths No. Floors No. Rooms Rec. Room
TYPE Yc�J'NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. / I
4-1-. N
7. OF ,�.,/A ❑ OTHER -
WORK 4J,�LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBES._'ORK
8. RES/p ' lGt' — p. c.< A--r' c.4 E -- 0 UAgArG� FEES COLLECTED
VALUATIONSource GAS ELECTRIC WATER SEWER
9. LF7 50000 Utilities gg s5P-nc..
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
' on
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building Sp V
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 regulac,sting construction or the
performance of construction.JPlumbing
DATE 'r/' " `� /' "3 ruq SIGNATURE_ a Mech.
1
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. 01Z ON FILE 1-17-go o Plan Check
Env.Health , - 0� �A �y� cD
4 4 f&) t /l/7 y K I SEPA C)
J
LU
Planning — a.
Mobile Home
Fire Marshall
Co. Engineer Other(Specify)
Utilities
TOTAL $
Zone Clearance
• WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist - THIS CA rcyMIT. 3 0
�11/ GO�� � _66. 5 * 5G. 00ai-
DATE /� OFFICI
APPROVED FOR ISSUANCE —
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5215 S. CONK!. IN RD.
GREENACRES, WA. 99016
(509) 924-6133
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