1979, 11-01 Permit: 79-7151 Gas Piping'LAN 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.
JOB ADDRESS
LOT
2.
BLOCK
d
DIVISION
LEGAL DESCRIPTION — SEE ATTACHED
3.
OWNER
ADDRESS
PAA 3 lLit 11
C h0U_
CONTRACTOR
4. ADDRESS / „ �" A`
[(/►�/ � C� C� l it' mss. {t(7l 1+1P
DESIGNER
5' ADDRESS
6.
CHANGE OF US
FROM
TO
PHONE
CI (7)`�7
q4d�
PHONE
PARCEL NUMBER/5
Required Set Backs in Feet
North 'South
East
Size of Parcel
Zone Classification
ZIP99,4Q7
Type Const.
Occupancy
Sprinklered
❑Yes ❑Nn ❑ Req'd.
PHONE
?as wf-AaO
ZIP
Valuation
Building Area in 5q. Ft.
DWL Area I Basement Area ( Garage Area I Storage
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
la NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N. 0 RPL. 0 MVE.
MECH: ❑ M.H. 74 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
,/AO'( -as �IOt
G
Source AS
o
Utilities
roar 'ice a n ( )`-
ELECT RIC
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
�(ov-e 1 I 1171
SIGNATURE We
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Fnv. Healt)
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/75-000 cc0 T1} ?old
-�--y�r
,�-e,ts-XiZ _ C14co)
I't'h!Y
DATE 0-1-77 OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ / -
n J PERMIT NUMBER
G 7q-7/5/
DATE'10--u-ri 1 / / 7 71
04* *14,00
* 14.00 to -
* 1 4.006
E *000
7150A
11-01-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11;01-79
715,12
DA rE REMARKS
4
•
RECORD OF INSPECTIONS
...+Pa• dog%
Final Inspection
INSPECTED BY
*.• 9 LI A
J1 - I
if 1 ‘'
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