1979, 09-11 Permit: 79-3792 Water HeaterLLAN 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.
JOB ADDRESS //
�. 17 D6,00 O`
LOT SUBDIVISION
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
nE
3 OwDje/'t Ce/
t7R13/ Bo/r'e)a�
CONTRACTOR
a ►,1 �e
4.
ADDRESS
PHONE / 1
DESIGNER
5' ADDRESS
'o 37
PHONE
Required Set Backs in Feet
North 'South East 'West
ZIP
PHONE
ZI P
Size of Parcel Zone Classification
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. 0 POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCR BE WORK
8. e�1a���
VAL ATION q
9.
/1071- t,aaiee Peclr
GAS
Source
of
Utilities
ELECTRIC
WATER
SEWER
1 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 construcion or the
performance of construction.
DATE 9-71/— 79 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. He$Ith
Plann
ing
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
a/V ti No" Lock
DATE9/1'/ 14-OFFICI —
/ APPRI ED FOR ISSUANCE
1
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
-79 "."7`77 --
DATE T72 -
DATE
04* *5.50
*5.50
*5506
E *0.00 0
379.1
09-11-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THISn COME A'TMIT.
379,2(5
*5.502f