HomeMy WebLinkAbout1979, 12-03 Permit: 79-8576 Conversion BurnerPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
9/Z3
LOT
1.
LOT BLOCK re(BDIVISION
2.
OWNER
3. ADDRESS
c--,vA e
CONTRACTOR vt
4' ADDRESS
DESIGNER
LEGAL DESCRIPTION - SEE ATTACHED
PHP ^'F
ZI P
PARCEL NUMBER /S
Required Set Backs in Feet
North
South
P,H0 E
�- -4676
ZIP
Size of Parcel
Type Const.
Occupancy
PHONE
Valuation
East IWes
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area Basement Area
Garage Area
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
OIL
TO
V
Split Entry
Split Level
❑ NEW ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. 2 MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Storage
Rancher
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WOR
8.
VALUATION
9.
Source
of
Utilities
ecriviw,0 LutJ
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. , 11
DATE 1 L�—( SIGNATURE I . ■Aii&.
l
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDI ONS:
/O`D h't /37 a ( &11.0--
(Litislittk 4-- 0-64 , sp >
l./yy9 6-trC.
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DATE _ .47/11 ‘21.,'L'T -e-j-
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �•
PERMIT NUMBER
7 -z3-77
04* *1200
* 1200 6-
* 12008
B *Q00
857,52
12 -03 -79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12L0`3': -,7'9 857.6 *12.0021
RECORD OF INSPECTIONS
4, S 0
Final Inspection
REMARKS INSPECTED BY
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