1979, 10-22 Permit: 79-6490 Damperr7=
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
LEGAL DESCRIPTION —SEE ATTACHED
LOT I BLOCK ISUBDIVISION PARCEL NUMBER/S
NER
PHONE
if lu re
3. 6 ,- t� fl t�
&,.
ADDRESS, _ /
"
ZIP �7
9d(e
Required Set Backs in Feet
I 6- E ., C� �G
North South
East West
C NT ACTOR (
U AL ; .T �% % Li 4EL+6C:
PHONE
Size of Parcel
Zone Classification
4. ADDRESS _
ZIP
Type Const.
Occupancy
Sprinklered
I L�. E, 1 j�2 k� A_
`7 6e-1.
❑Yes ❑No ❑ Req'd.
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 1:1 ALT. � AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
El BLD. ElPLMB. ElMECH: ElM.H. El POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd
WORK
of EXEMPTION
DESCRIBE WORK
FEES COLLECTED
8 Y
VALUATION Source AS0 ELECTRIC WATER SEWER
Q, 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 I al law regulating construction or the
performance of construction.
Plumbing
�1 _�/
DATE SIGNATURE 1�.. 11'x'"'�
_
6�-
Mech.
SPECIAL APPROVALS SPECIAf CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
l
TOTAL $ '
Zone Clearance
SEPA Checklist
DATE�Q OFFIC
�APPRFOR ISSUANCE
DATE
PERMIT NUMBER
v tc+ /
�4 i
04* *7.00
*7.00
*7.00
E *0,00 n
6489
10-22-79
;R 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-2 2"-7 9 6'1`9.,0
*7,00.0°_