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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 SEPA Checklist