1979, 09-11 Permit: 79-3778 Furnace, DuctworkPLAN 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
1.
2.
3.
JOB DRE /
LOT BLOCK SU DIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
OWNER
ADDRESS
PHONE
ZI P
Required Set Backs in Feet
North (South [East (West
CONTRACTOR
4. ADDRESS
DE SUER
5. 1--�—
ADDRESS
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
PHONE
Valuation
ZI P
DWL Area I Basement Area
Building Area in Sq. Ft.
Garage Area I Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
EW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD.
❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors No. Rooms
TE
CERTI FICA
of EXEMPTION
Req'd.
Rec. Room
Rec'd.
Not Req'd.
9,ESCRI E WORK
8. ok l‘ti
VALUATION
9.
Source
of
Utilities
GAS
ELEC
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 local law regulating construction or the
performappe of construction.
DATE
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D_ REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE /
W
APP D FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
DATE
PERMIT NUMBER
79"`37%
04* *7,00
*7,00
*7.006
E *0.00 8
377.72
09 -11 -79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COMES A PERMIT.
0i' -7, 377,85 *7.002
RECORD OF INSPECTIONS
Final Inspection
REMARKS INSPECTED BY
11-A6
40N. 2
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