1979, 10-10 Permit: 79-5668 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
1.
LOT
BLOCK -SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
2.
OWNER
3 ADDRESS
PARCEL NUMBER/S
PHONE
d 3 - a- { ri a.
39 a� 1151,
ZIP
Required Set Backs in Feet
North (South East (West
CONTRACTOR
4' ADDRESS
PHONE
Size of Parcel 1 Zone Classification
3ocl1 �= „t -
ZIP
q(�c.
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Split Entry
Split Level
Rancher
14 NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
❑ BLD. 0 PLMB. Q\MECH: ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
G
C k. -)Ci 1
AS EXL CTRIC
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 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
1
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE14( 1,11 J 7 FFI
APPRO
OR ISSUANCE
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �. �� CD
M
DATE /6- $ - 7 Cf
PERMIT NUMBER
may- 56,6e
04* *7.00
*7.00
*7.006
E *Q00 S
5667
10-10-79
679.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COMESIA PERMIT.
1U-.10-7' 5'66,82 *ZOO
O' J
aI