1979, 11-19 Permit: 79-8100 FireplacePLAN 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 ADDRES � .:72,2
LOT SUBDIVIS ON
BLOC
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
ADDRESS
PHONE tO/�
p
9—,/ /
ZIP
Required Set Backs in Feet
North 'South East 'West
5.
71 ACTOR kla .
ADDR E$S
DESIGNER
ADDRESS
a Sem �G
P�Hpp NE
h`f 5 4E76
ZIP
192.07
Size of Parcel
Type Const.
Zone Classification
Occupancy Sprin_klered
Oyes ONo 0 Req'd.
PHONE
Valuation
Building Area In Sq. Ft.
ZIP
DWL Area !Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
O NEW
❑ BLD.
O ALT.
❑ PLMB.
O AD N.
MECH;
O RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
8.
9.
DESCRIBE WORK
VALUATION
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. Alt 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 //—/979 - SIGNATURE
DEPT -
4
SPECIAL APPROVALS
REQ'O. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL Afar, OCa4-11—.
FEES COLLECTED
Single
Building
Plumbing
Mech
Plan Check
SEPA
Mobile Horne
Other (Specify)
PERMIT NUMBER
7Q-27.0()
DATE Z?s- - J, /V77
TOTAL $
04* *7.00
*7.00 to
*7.006
E *Q00 8
809.92
11=19-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
111.!19'-7+91 81Q0Z
A7,00a!1—
APPROVED FOR ISSUANCE _