1979, 09-27 Permit: 79-4817 ResidencePLAN NUMBER APPLICATION/ PERMIT
12 - 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 L DESCRIPTION — SEE ATTACHED
LOT BLOCK ISUBUIVISKIN 7PARTELUMBER/S 3 — QrBO 3 di2Tiov
2. 5- � i ' LD ( cam
OW R PHONE APO
1 11 ��4 7
3 ADDRESS
Z
Required Set Backs in Feet
North ` South ,5
East ='4 West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4' ADDRESS
ZIP
Type Const.
Occupancy
SFprinklered
VAI
t e - 3_
[]Yes Zo ❑ Req'd.
DESIGNER
PHONE
Valuatiph
Building Area in Sq, Ft.
DO
.baic
5.
ADDRESS
ZIP
OWL 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
❑ ALT. ❑ AD'N. ❑ RPL.
❑ MVE.
„.
Ls
7, OF
❑ BLD.
❑ PLMB. ❑ MECH: ❑ M. H.
El OTHER
❑ POOL
CERTIFICATE
Req'd.
Rec'd.
Not Req'd.
WORK
of EXEMPTION
I
DESCC1jBE WORK
FEES COLLECTED
PERM! iUME,11ER
�9-7 8I
DATE 9- 2.`7?7
02* *265.00
*265.00 �
*265.00
B *0.00
481,62
09-27-79
-4 6.479,
8. _
VALUATION Source AS ELECTRIC WATER SEWER
of
9, / Utilities Single $c!
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 law r ulating construction or the
performance of co truction. Plumbing
�a
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT, REQ'D. RECD. - 1^/JD IV Plan Check
Env. Health `� X" C4�
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer Other (Specify)
Utilities .�U
TOTAL $ U6 "'�
Zone Clearance
WHEN MACHINE VALIDATED I
SEPA Checklist THIS BECOMES A PERMIT.
DATE �-�" ( OFFICIAL,—U
APPROVED FOR ISSU CE
481.77 *'265,0OI2�--j
77.37