1979, 09-27 Permit: 79-4858 Plumbing FixturesPLAN 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
�� LEGAL DESCRIPTION - SEE ATTACHED
LOIr 1 BLOCK ISURDIVISION PARCEL NUMBER/S
OWNE `
3. m4
ADD SS
CO ACTOR
4. A D ESS
DESIGNER
�' ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
uired Set Backs in Feet
th South East West
PHONE
e of Parcel
Zone Classification
Z Q
ype Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
uation
[No.
Building Area in Sq. Ft.
ZIP
DWL Area
Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
Baths
No.
Floors
No. Rooms
Rec. Room
TYPE 1!; W ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF,.�� ElOTHER
WORK —1BLD. Iid�PLMB. ❑ MECH: ❑ M.H. El CERTIFICATE Req'd. I Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8 FEES COLLECTED
VALUATION ce GAS ELECTRIC WATER SEWER
f
to IPEIYMIT NUMBER
�-� - q
DATE 11117
03* *28.00
*2800
*28.00
E *0,00
485,7
09-27-79
;2 6479.
9,
Utilities
Single $
1 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 regulating construction or the
ZS aC7
performance of construction.
Plumbing
p
DATE y/ 71�/ SIGNATURE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT, REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Speeif )
Co. Engineer
Utilities
a
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
d
10FFICIAL �` �`%
THIS BECOMES A PERMIT.
0 9, .2 —% 9 �
DATE"///
�� �
APPROVED FOR ISSUANCE
4