1979, 09-14 Permit: 79-4002 Addition PLAN R'UMBER /^(y'; Q
APPLICATION/PERMIT � � PEFr OttLUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 2 * * 1 A,0 0
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED * 1 A.
0 0 N
L -r- BLOCK SUBDIVISION PARCEL NUMBER/SiOC _ i
2. 151& 2K-0K -(o�N
09- 1 4-79
OWNER PHON=
3. 4/ 16-1\1G6 K. 15L K., ',2, i504-- 2 6.479,
ADDRESS
Required Set Backs in Feet
107167`41- H-sv ,,,2.62
North 1...: ISouth East V
'West
CONTRACTOR
PHONE Size of Parcel ZoAClaoicati 1IA`1J-
Ivl (//
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
.QD _
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 0 NEW 0 ALT. er:AD'N. 0 RPL. 0 MVE.
7. OF ,��- ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK LJ BLD. El PLMB. ❑ MECH: ❑ M.H. ❑ POOL
of EXEMPTION
8.
DESCRIBE wO✓- K-r thIfN�V_ rrIOH / c2x 10) (pf,i4 1( FEES COLLECTED
611V
ALUATION Source GAS J` ELECTRIC WATER SEWER VJ
/�,r� of i G
9. t�`�v of
I"� 'V Single $ —
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included 4 1+i Qv
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
Plumbing
performance of construction. n
DATE y///,3/7 9 SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
it b .\ Plan Check
DEPT. REQ'D. RECD. �yf �J 7} P� /
Env.Health •
/ /,
/ A1-_ tom'A. Fes, , /,_--;/-77
-- /,/, p A1.1 1 ,66f IWs��� (c [Ca SEPA a
Planning 2
Mobile Home n
Fire Marshall
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance ',..'
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BgCOMES A'7P RMIT. 'I 0
SEPA Checklist !?/ �� y�-,' 0 ; 1 U.t- !Ej `�' w 0,2 z * 1 4, 6 W. 'rJ
DATE 'I/-'IGY►„ ,-/�-� 0FFI0t���a�+--�
��—APP=t ED FOR ISSUANCE —
14 NI* rod 14.
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40 12-1[74
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45
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