1979, 09-06 Permit: 79-3471 Gas Furnace, Ductwork(ii PLAN NUMBER
A
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
ret
LOT BLOCK SUBDI 1 N
OWNER y
1
3. ADDRESS
A r %S'C/ R 4 f X K� / /lice/ L
CONTACTOR
/`/1"/ a 6(42- /yy f/
4' ADDRESS �
r I.z 7/d 1-4--4/1. a,1- 1 S/eyeA., .
DESIGNER
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
i/
ZIP
�r"3iSjfj
PHONE
C
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
ZIP
/
PHONE
ZIP
TO
KNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. Cl PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
9.
DESCRIBE WORK
/Ns /C[ / 6e1 S Fi-e
VALUATION Source
of
Utilities
GAS
ELECTRIC
Required Set Backs in Feet
North
South East
Size of Parcel
Type Const.
Occupancy
Valuation
DWL Area
Basement Area
Split Entry
No. Baths
Wes
Zone Classification
Sprinklered
Elves ElNo ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
Storage
Ranche
No. Floors No. Rooms
Req'd.
CERTIFICATE
of EXEMPTION
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.
DATE y— 7 77' SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
f1,e ,ciCA S'cY, 'OC/ L 7Z l<,/s
■/
p, p
DATE
OFFICIA��
APPROVE FOR ISSUANCE
Rec. Room
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. 2. cc)
A
Plan Check
/w' 4/i! 6. Lac)
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 00
DATE
I,
PERMIT NUMBER
04*
A
347,02
09 -06 -79
2 6479,
* 12.00
* 1 2,00
* 12006
*000
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-06-79 547,12 *1200a1-2
DATE REMARKS
— il9—
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
1 QctVi
0a -0Q -Ja
21,10%
V '000
* Js00R
ri
• 1500
* i50r: