1979, 09-27 Permit: 79-4821 ResidencePLAN NUMBER _ T
APPLICATION/ PERMI
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 j PARCEL NUMBER/SJEIeo8
Ow
3. 14
ADDRESS
ON RAGC' OR
4. ADDRE
DESIGNER
5.
ADDRESS'
8'Y
CHANGE OF USE FROM TO
6.
P-OO
Z1�r9
PHONE
ZIP
PHONE
ZIP
TYPE �N W ❑ ALT. ❑ AD -N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
,C,UT A*51-1<
FEES COLLECTED
4,:Er
A DLL?
Required Set Backs in Feet
s
Source
y
North �i South d
,+
East ! West
Size of Parcel
Zone Classification
9
Type Cpnst.
Occupant
�Sp/rinklered
/a�/�
--
❑Yes 13jNo ❑ Req'd.
Valu t' n
Building Area in Sp. Ft.
DWL Area
Base Rt Area
Garage Area
Storage
to give authority to violate or cancel the provisions of any other state or local la# regulating construction or the
v
Plumbing
Split Entry
Split Level
Rancher
DATE SIGNATURE
Mech.
SPECIAL APPROVALS
No. Baths
No. Floors
No. Rooms
Rec. Roor
Plan Check
Env. Health
CERTIFICATE
Req'd.
Recd. TQti
Planning
of EXEMPTION
I
DES bBE WOR Q�
,-,
FEES COLLECTED
8 , P _ /� /0
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9
of
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 local la# regulating construction or the
Plumbing
performanpe of C nstruction.
�5
DATE SIGNATURE
Mech.
SPECIAL APPROVALS
SPECIAL C ITIONS:
DEPT. REQ'D- REC'D.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
Zone Clearance
SEPA Checklist
TOTA L $
WHEN MACHINE VALIDATE
9 THIS BECOMES A PERMIT.
DATE I OFFICIAL`L-L4-0 /Q �- I
APPROVED FOR ISSU CE
PERMIT UMB��.
q zl
DATE 9-77-71
02* *251.'50
*251.50 tn-
*251.50
B *0,00 8
48202
09-27-79
–4 6.479.
IS SPACE,
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