1979, 09-04 Permit: 77-3323 Addition(PLAN 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
LOT B OCK SUBDI ISION2. C 1-12.4"1-14-` %�
ER •
3. .4-,G,C2,-4-1
DRESS
', 4z zz,- 121-2-4
CONTRACTOR
4 .J•liv��
• AOQ RESS
RCJ�i OYIi'��
DESIGNER
9,24
ZIP
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S pDRr—.21p�`'Sl`2-94/u
L'rY 8LK a.3
,E4 R IS ,DA W AQ
/ I A A D D
Reelv1red et Backs in Feet
/I
North 3Q / 'South 49,3fEast -2 / 'West . '5
Size of Parcel Zone Classification
` )c /66 / .
ZIP
Type
Const.
Occupancy
M—/
/ �SS,prinklered
❑Yes L "10 ❑ Req'd.
PHONE
Varl—ialion
O
Building Area in Ft.
Ft.
ADDRESS
ZIP
DWL Afea 1 Basement Area
Garage Are9 Storage
�—
6.
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
❑ NEW
0 BLD.
❑ ALT.
❑ PLMB.
AD'N.
0 MECH:
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
CERTIFICATE
of EXEMPTION
No. Rooms
Req'd. I
Rec. Room
Rec'd.
'Not Req'd.
DESCRIBE WORK
8.
VALUATIO
9.
S rce GAS
of
Utilities
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 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.
•
SIGNATUREIAA
DATE Sr —Z Z.- 7q
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIA-' (- < /
n
nnnv
nrn rnn Inrvina�rnr
FEES COLLECTED
Single $
�27ov
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ .l 7
Od
�'1� P�EFii�IT N 6/IBER
7 I - 33-Z,3
DATE 9-174-79
02* *27.00
*27.00
*27.006
E *0.00 0
3322
09-04-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-04-79 3.3235 *27.0021-2
INCPPrTnP