1979, 09-11 Permit: 79-3790 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 in
5 /777 .0(/aar
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
3.
4.
Abe /1 f ire/I
RESS
DDS. l7/7 An //CI0r
CONRA TOR
PHONE
9 a--c;)</2o
ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
O BLD.
O ALT.
O PLMB.
L
c.s37
PHONE
Required Set Backs in Fee
North 'South East
West
ZIP
Size of Parcel Zone Classification
PHONE
ZIP
TO
❑ AD N.
O MECH.
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
Type Const. Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
Valuation
DWL Area
No. Baths
CERTIFICATE
of EXEMPTION
Building Area in Sq. Ft.
Garage Area
Split Level
No. Rooms
Storage
Rancher
Rec. Room
Req'd. Rec'd.
pESCRIIE WORK �^
• KrIlet 6/1 1�G 15 Ft e / Cr
VA UATION
9.
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. 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 1• .1 law regulating construction or the
performance of construction.
DATE 9 Y//- 79
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
677/ ov
DAT E�
11
r
OFFICI
APPR FOR ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
3 77-0
04* *11.00
* 11.00
* 11.000
E *0.00
378.92
09-11-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-11-79
79.00 *IA ,00°�