1979, 07-12 Permit: 79-414 Convert BoilerPLAN NUMBER
APPLICA'*IOLI/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
LOT
2.
BLOCK
908 asf &cn
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
Ere.cJ sett rkh r<
ADDRESS
t art
J1 i&o
CONTRACTOR%� v�r� 77
4. v1-Jn if r1 ,
ADDRESS
Sao 3 N . �'resLt
DESIGNER
5. ADDRESS
PHONE
-P8e6y2
ZIP
CM 20.6
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East 'West
6.
CHANGE OF USE FROM
O/L
TO oa
PHONE
Oil '/O? R
ZI P
Size of Parcel Zone Classification
PHONE
ZI P
Type Const.
Occupancy
Valuation
DWL Area
Split Entry
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Basement Area Garage Area
Storage
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW .ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB.°N.MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK n/� / ! �� &
8. (..Ob vt rtea` L?4r /0 ex3 Cl6!`f'r,
VALUATION
9. 0/
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 local law regulating construction or the
performance of construction.
DATE 7 Z—^ ?'7 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. ,
�'.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
-74/ERV
DATE DATE
04*
* 14.00
* 14.00
41,32
07-12-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-12-79 41,44
*1 40,0 °F
DATE
RECORD OF INSPECTIONS
Final Inspection
REMARKS INSPECTED BY
t12%
•J V' 0 0
Ct►+ 4J TOO