1979, 12-03 Permit: 79-8630 Forced Air FurnacePLAN NUMBER
APPLIt•A 'ION /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
1.
2.
3.
4.
JOB ADDRESS
r'` ��✓�o ,kL'1,<I
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
ADDRESS
d6
CONTRACTOR (\16.
ADDRESS
H-790 k
DESIGNER
5' ADDRESS
54 g�&
,ZG/IP
PARCEL NUMBER /S
Required Set Backs in Feet
North 'South [East (West
P ONE
- 844 -r
ZIP I
PHONE
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area Basement Area Garage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NJ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. M.H. ❑ POOL
8.
❑ OTHER
No. Baths
No. Floors No. Rooms
CERTIFICA TE
of EXEMPTION
Req'd.
Rec. Room
Rec'd.
Not Req'd.
DESCRIBE t/ K A li-- �- s �� Cl6 o1 ooc °-rLJ> VALUATION Source GAS ELEC RIC WATER
of
9. Utilities
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 grar v ng of a permit does not '.resume
to give authority to violate or cancel the provisions of any other state o i . law/ gulatJ 'n� ili'•n or the
performance of construction.
DATE
DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SIGNATURE
SPECIAL APPROVALS
REQ'D. REC'D.
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
Gdk-f. IX- - c- GOO - 3 .2D- 5
DATE
ED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
cam, 0�2
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
/10-
DATE
PERMIT NUMBER
77 -
04* *9,00
*900 V)
*9.006
B *Q00 S
862.98
12 -03 -79
g 6471
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12 03'=;7191 8'63,0 z
*9.00°
1,1
RECORD OF INSPECTIONS
DATE REMARKS
Final Inspection
INSPECTED BY
J —02
. ,
c14 r 0