1979, 10-12 Permit: 79-5844 FurnacePLAN 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 ADDRESS
_ jL ✓i'/ 1✓
6(7/
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER /S
OWNER
rl .'1.
ADDRESS
PHONE
ZI P
CONTRACTOR
4. `',f
ADDRESS
DESIGNER
GJ. ADDRESS
PHONE
-4 ✓S�
Required Set Backs in Feet
North (South [East (West
Size of Parcel
Zone Classification
ZIP
✓
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
KNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ;N MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors No. Rooms
CERTIFICA TE
of EXEMPTION
Req'd.
Rec. Room
Rec'd.
Not Req'd.
DESCRIBE WORK
8. r �,
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
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
performance of construction.
(y /
DATE /VI)/ 4 /7 1 SIGNATURE_ i�! %
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFI
APPR
FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
DATE 1!/ /i -//J <J"
04 *• *700
*7.00 N
*7,006
E *000
584,32
10 -12 -79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
TH IS1BFOTF„S%A k, EMIT.
584,42
* %0 0a1-
0
RECORD OF INSPECTIONS
REMARKS
•
Final Inspection
INSPECTED BY
QC1,�G
10715-A6
• 241
C
41•00
it
4 t;;
y. 1'0 0