1979, 11-01 Permit: 79-7108 Plumbing FixturesPLAN NUMBER APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBOIVIbIQN PARCEL NUMBER/S
2.
OWNER //
3. III -le to l
ADDRESS
CONTRACTOR
4. ADDRESS
,4:— /- �
DESIGNER
J. ADDRESS
l Pry !�i/rGsC�/ah
CHANGE OF USE FROM ITO
6.
PHONE
ZIP
Q
PHONE
ZIP
PHONE
ZIP
TYPE kNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
% OF WORK ElBLD. PLMB. ❑ MECH: ElM.H. El POOL ❑ OTHER
equired Set Backs in Feet
Orth South
East West
ize of Parcel
Zone Classification
GAS
ELECTRIC
Type Const.
Occupancy
Sprinklered
of
[--]yes [—]No ❑ Req'd.
aluation
Building Area in Sq. Ft.
9,
DWL Area
Basement Area
Garage Area
Storage
Single $
Split Entry
Split Level
Rancher
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 regulating construction or the
No. Baths
No. Floors
No. Rooms
Rec. Room
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ -D. RECD. Plan Check
CERTIFICATE
Req'd.
I Recd.
Not Re
of EXEMPTION
Planning
Mobile Home
P1PERMI�1 NU,4BER
V'716A I
03* *35.50
*3550
*35.504
E *0.00 00
710.7
1 1 -01 -79
;F 6,479.
DESCRIBE WORK
FEES COLLECTED
� 4 � �
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
of
9,
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 thisBuilding
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 regulating construction or the
Plumbing
performance of construction.
DATESIGNATURE T/ l� Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ -D. RECD. Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer Other (Specify)
Utilities
"d
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklistr THIS BECOMES A � RMIT.
_ 1 C 6
DATE '� OFFI y
APP FOR ISSUANCE
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