1979, 11-16 Permit: 79-7947 AdditionPLAN NUMBER
APPLICAMN/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
1.
1 1-21
LOT BLOCK SUBDr'YISION
As, xtr—
PARCEL NUMBER/S� n,?/
2.
/04/� �d
OWNE
PHONE
3.
ADDRESS
ZIP
Required Set Backs in Feet
% i/
/
RG O (0
_
North South East West <5 �
CONTRACTOR
PHONE
Size of Parcel Zone Classification
WHM
4.
ADDRESS
ZIP
Type Const. Occupancy Sprinklered
_SS
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation Building Area inISq. Ft.
F,�7
_C.
5.
ADDRESS
ZIP
D L Area/
Ba ment Area
I Garage Area Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6
No. Baths
No. Floors
No.Rooms
Room
TYPE El ❑ ALT.
,� AD'N. ❑ RPL. ❑ MVE.
I
I
--
7,
OF
❑ BLD. ❑ PLMB.
❑ OTHER
❑ MECH: ❑ M.H. ❑ POOL
CERTIFICATE
Req'd.
I Recd.
Not Req'd
WORK
of EXEMPTION
DESCRI,PE ORK
8.
ALUATION �� Source GAS ELECTRIC WATER SEWER
;�)c/5= of
9. /j/Jel) utilities
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 regul ting 'construction or the
performance of construction.
DATE//<� --Z SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env eal
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIALC
ITIONS:
DATE 111- OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Z-),9
Building
Plumbing
Mech
Plan Check
DATE
G2* *6800
*6800
*6800
L *0.00
794,6<
11-16-79
P
6479.
rr
J
SEPA U
_ w
Mobile Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
} l-� 6-7'9
*68.00
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t�RES SEPT��
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