1979, 10-01 Permit: 79-6249 ResidencePLAN 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
�, Gila � r, --r14 LEGAL DESCRIPTION — SEE ATTACHED
�.
2 �T BL,OCK SUBDII01 W ON � 6 r_1 ���
OWNER I I�PARCEL NUMBER/S
M
3. IJ
ADI RE S
C0 NI :.R✓� T
4. ADDRESS
DESIGNER
5. ADDRESS
PHONE
9zG-a-Z
Z
Required Set Backs in Feet
North South
PHONE
Size of Parcel
ZIP
Type Const.
Occupancy
PHONE
Valuation
ZIP
DW�494
i3$
Baseme re
�
ast dL-0 West �_2-0
Zone Cla sipcation
Sp inklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
e
CHANGE OF USE FROM
TO
Split Entry
SpliYLevel
ELECTRIC
Rancher
6.
9;
V
Single $
No. Baths
No. Floors
No.
ooms
Rec. Room
TYPE F/NEW ❑ ALT.
❑ AD'N. ❑ RPL. ❑ MVE.
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
I
Plumbing
I
7, OF
IP/BLD. ❑ PLMB.
❑ OTHER
❑ MECH: ❑ M. H. ❑ POOL
CERTIFICATE
Req'd.
SPECIAL C NDI .
Recd.
Not Req'd.
WORK
Plan Check
of EXEMPTION
1
/J L'
DESCRIBE
WORK
FEES COLLECTED
8.
VALUATION Source
56 3if
Utilities
G S
ELECTRIC
WATER
�
EWER
9;
V
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
4E
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
14 .
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
Plumbing
performance of construction.
DATE SIGNATURE
15
Mech,
SPECIAL APPROVALS
SPECIAL C NDI .
DEPT. REQ'D. RECD.
la A h1/ _ /�f LCl/�
Plan Check
Env. Health �O /
1
/J L'
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
P4N3 0 k
r
DATEl0.l6-7q OFFICIALS/��-�
APPROVED FOR ISSUANCE
�- - PlRMI NUM 'ER
DATE lG�_` Z_
02* *301.00
*3'01.00 IV-)
*301.00c"
E *000
624,8-9
10-17-79
;F 64'79.
TOTAL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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