1979, 10-12 Permit P-79-2613 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
4
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. A%- �2 Zd &d-�-1v -.
LO BL CK SUBDIVISION
2.
OWN
3. Y.C1 6 /S o A/
ADDRESS of
Aiti
CONTRACTOR
7`tiJ. A E r�r //Vt sus, 2 NC
4' ADDRESS
DESIGNER
5' ADDRESS
atIONE
ZIP
PHONE
z--s - W z
ZIP
North
Size of Parcel
Type Const.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
(South
Occupancy
'East 'West
Zone Classification
Sprinklered
Elves ❑No ❑ Req'd.
PHONE
ZIP
Valuation
DWL Area I Basement Area
Building Area in Sq. Ft.
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
D BLD.
❑ ALT.
PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESC I E WO
8. IK,
7t .cE
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
L7�
SEWER
/� ioVk
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 d• of p esume
to give authority to violate or cancel the provisions of any other state or Ical regulating ••nstruction or the
performance of construction.
DATE
lc)
SIGNAT
DEPT.
SPECIAL APPROVALS
RFQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
7, SCi
O er (Specify)
TOTAL $ 4:h SO
PERMIT NUMBER
DATE '?�C/7
,U(3* * 1 050
* 1 0,50 to-
* 1 0.506
A *000 8
261.22
08-22-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-22-79 26139
*10.502F
DATE
OFFIC • L
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En GfSD Iccllnnlr`E