1979, 09-04 Permit: 79-3333 ACPLAN 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
4.
LOT
BLOCK
SUBDIVISION
OWNER
.7)
u / R -
PHONE
PARCEL NUMBER/S
ADDRES
CONTRAC
ZIP
PPHHLONJ/�E
'/Cl % X)
Required Set Backs in Feet
North 'South [East 'Wes
Size of Parcel
Zone Classification
6,6) X76'
DESIGNER
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
Eves ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ PLMB. XMECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION Source GAS ELECTRIC WATER SEWER
of XQ, Utilities
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
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
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
OFFICI
DAT `—'
APPR D FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
DATE
PERMIT NUMBER
- 3�3b
*7.00
*7.00 N
*7.006
A *000
333.2
09-04-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS 0BYCOIU 4— j;E�iMIT. 3 3 3, 3
*7,00