1979, 11-13 Permit P-79-7673 Plumbing FixturesCLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
3.
4.
5. ADDRE
JOB ADDRESS
LOT
OWNER
BLOCK
ADDRESS
CONTRA OR
/!'iWli `JLc
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
SUBDIVISION
ADDF3i
6.
7
Dr&hBPo'L R 1 D
CHANGE OF USE FROM
TYPE
7. OF
WORK
8.
9.
64574
PHONE
PHONE
y�� .igy,
ZIPn
7s7/
.NEW 0 ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. 0 POOL
DESCRIBE WORK
VALUATION
Source
of
Utilities
GAS
❑ OTHER
ELECTRIC
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North
Size of Parcel
Type Const.
Valuation
Split Entry
No. Baths
South East
Occupancy
West
Zone Classification
Sprinklered
Yes DNo ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
WATER
SEWER
No. Rooms
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. T•ranting of a permit does not presume
to give authority to violate or cancel the provisions of any other state . .clal lawreglatiflg construction or the
performar}Ic� cyF cons7uction.
DATE
DEPT.
/ 79
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CNDITIONS:
DATE OFFICIAL
APPRf11/F(1 rnp IQQIIANCr
Storage
Rancher
Rec. Room
Not Req'd.
FEES COLLECTED
Single $
Building �
Plumbing w ` SC/
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
DATE
PERMIT NUMBER
- 7& 3
*4Q50
*40.50 tz
*4Q506
• B *0.00
767.22
11-13-79
6.479.
03*
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1N13�79 767,32
*40.50g�
I•
[
L
c