1979, 11-16 Permit M79-7954 InsertPLAN 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
LOT
5Zo E. NO(2..A
BLOCK
SUBDIVISION
OWNER
3 STEVE STAcfk' FSKY
Al..720 E• NORA
4' ADDRESS
CONTRACTOR
SAME
PHONE
ZIIP
6'i 2.0 co
PHONE
ZIP
DESIGNER
PHONE
ADDRESS
ZIP
CHANGE OF USE FROM
6.
TO
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER'S
Required Set Backs in Feet
North South East
Size of Parcel
Type Const.
Occupancy
Zone Classifica
West
ion
Sprinklered
Yes No ❑ Req'd.
Valuation Building Area in Sq. Ft.
DWL Area
Split Entry
Basement Area Garage Area
Storage
Split Level
Rancher
TYPE
7, OF
WORK
YJ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. CJ MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
DESCRIBE WORK
ins-ALLINSERT
VALUATION
9.
Source
of
Utilities
GA
L2
EL
RIC
WATER
SEWER
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// /6 '/ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D_
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SPECIAL CONDITIONS:
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
-7
$
//1
PERMIT NUMBER
lq -`7q 5
DATE
04-0
oy 1- 6p 54
,crp TL
TM AT
?,53
11*
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE►\ 1(a -7 FFICIAL�� b -7 7 9 5.4 z ,*7. 0 0 P-
APPROVED FOR ISSUANCE
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