1979, 08-10 Permit: 79-1992 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
F
LOT
BLOCK
OWNER
SUBDIVISION
3. G/11“6.4 17c)A1.6S
PHONE
tab --63e/
ADDRESS
Y.603 igootie���
C NTRACTOR
ADDRESS �
e41 7 / C! //V(/' a ., is . 5
DESIGNER
5. ADDRESS
'.pec
C -
ZIP
y9aa>6
PHONE Size of Parcel
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North
South
'East Wes
CHANGE OF USE FROM
6.
TYPE �Zl NEW
7. OF '`�l�
WORK ❑ BLD.
ZIP
72/
PHONE
ZIP
TO
❑ ALT. 0 AD'N. 0 RPL. ❑ MVE.
❑ PLMB. XLMECH: ❑ M.H. 0 POOL
0 OTHER
DESCRIBE WORK! / /. /' �/
8. I N5 / r�- f/ iii J F'c//t / C Pt 6,5 / : 0"...a�Ce C �f' La// fe '✓1 e-'/
VALUATION Source GAS LECTRIC
of
9. Utilities
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
DWL Area
Basement Area
Split Entry
No. Baths
Building Area in Sq. Ft.
Garage Area
Storage
Split Level Rancher
No. Floors No. Rooms
CERTIFICATE
of EXEMPTION
WATER
Rec. Room
Req'd. Rec'd.
Not Req'd.
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 3 % / SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITION
t-0,0 6Tu I=2,N‘12-.
39/ has
DATE 811 &y7 7,FFI
APPR
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
1 -'"CC rito.sea<aw
SEPA
vn
3. '0
4, ao
da„.,/ e4c t/- ov
Mobile Home
Other (Specify)
TOTAL $
6
PERMIT NUMBER
T19-- t 7
DATE
04* *1600
* 1600 UD
* 16006
A *000
199.18
08-10-79
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS COMES A PERMIT.
—10-79 199.25 *16.00°
ISSUANCE -
RECORD OF INSPECTIONS
Final Inspection
DATE REMARKS INSPECTED BY
08-10-J�
E
+►1 g00x
fpr
+►J900 P.
+►1000