1979, 10-12 Permit: M79-5912 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
JOB ADDRESS,
LOT BLOCK
,21 00.11 4AA-)
SUBDIVISION
OWNER
OWNER
3 ADDRE A
CONTRACTOR
4. ADDRESS � '1
-( 7/0 kaiatet44.47
49- tee..7z0
DESIGNER
5. ADDRESS
PHO E
ow
ZIP
CP/Q/6'
PHON
� • Qjt
6.
CHANGE OF USE FROM
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
ALT.
❑ PLMB.
PHONE
ZIP
TO
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
DESCRIBEWARK �
9.
VALUA ON
S urce
of
Utilities
I hereby certify that I have read and
on reverse side, and know the same
type of work will be complied with
to give authority to violate or cancel
performa nce of construction.
%
DATE / ( - 7 9
❑ MVE.
❑ POOL
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Required Set Backs in Feet
North
South
Size of Parcel
Type Const.
Occupancy
Valuation
DWL Area
East
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Basement Area Garage Area
Split Entry
No. Baths
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
GAS
ELECTRIC
x
WATER
Req'd.
SEWER
examined this application and have read the "NOTICE" provisions included
to be true and correct. All provisions of laws and ordinances governing this
whether specified herein or not. The granting of a permit does not presume
the provisions of any other state or local law regulating construction or the
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
REC'D.
Zone Clearance
SEPA Checklist
SPECIAL CjOJNDITIONS: ` /_
DATE t0/ / .OFFI
APP 'S
FOR ISSUANCE
Storage
Rancher
Rec. Room
Rec'd.
Not
Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
04* *9.00
*9.00 N
*9.006
B *000 °
591,12
10 -12 -79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 0'` -12 7'9
5'91,25 *9.00 �
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
(icrA6
J0-15—.16
261'1%
8 *OGO
46008
X00 P2
c 4 15. 0 0