1979, 08-08 Permit 79-1820 Addition9. too
PL �N 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
1. E ! / 3 2 R07911LL)/Y
LOT BLOCK SU DIVISION
2. b P O O ��Lih�,1 r`-' AP r
3 5iIP{N E &A►'U 455S -7 7,
ADDRESS
iE //30 RR.040)�Y
CONTRACTOR
4' ADDRESS
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
/oshi3- 0/0�
Required Set Backs in Feet
North (South [East (West
ZIP
Si a of Parcel Zone Classificatio
7 4,
Sprinklered
Des ❑No 0 Req'd.
Type Const.
Occupancy
DESIGNER
5. ADDRESS
PHONE
ZIP
Valuation (Building Area in Sq. Ft.
DWL Area I Basement Area
Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
❑ N 0 ALT_ IJ AD'N. 0 RPL. 0 MVE.
iD.. ❑ PLMB. ❑ MECH: ❑ M.H. 0 POOL
0 OTHER
Split Entry
No. Baths
Split Level
No. Floors
No. Rooms
Rancher
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Req'd.
Not Req'd.
8. DESK arc Na„ , V t7r6oH
VA UATION Sourc GAS
of
Utilities
ELECT C
WATER
SEWER
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 I. al la regt. sting construction or the
performance f contruction.
DATE g
DEPT.
?7
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
/
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CON•ITIONS:
L 7 z- m/))/7�
r
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
&.2-3
x
w I y,
* 1 9,00 5
* 19.006'
E *0.00
181.9f
08-08-79
? 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE
• OF I
�,-
08-08-79
182,0z *19.00°-12
AP RO FOR ISSUANCE -
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