1979, 08-16 Permit: 79-9188 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
11 1? -3 X30 o1,s W
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. A c A- IIL i&
ADD ESS
P o W Ia 4 #(
CONTRACTOR �p
4. e <* %'I 1 Xi" I ti G. -E-00.61-Am fIJC°
ADDRESS
DESIGNER
A-) kbiou
PHONE
°la -4- 14
ZIP
PHONE
/-410128
ZIP
9, y a c'
ADDRESS
CHANGE OF USE FROM
ik 6. • C—
TYPE
7, OF
WORK
PHONE
ZIP
TO
❑ NEW LALT. ❑ AD N. D RPL. ❑ MVE.
❑ BLD. ❑ PLMB. E MECH: El M.H. ❑ POOL
Required Set Backs in Feet
ilNorth 'South East (West
Size of Parcel
Type Const.
aluation
Occupancy
Zone Classification
Sprinklered
El Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area
Storage
Split Entry Split Level
No. Baths
CERTIFICATE
of EXEMPTION
Rancher
Rec. Room
Not Req'd.
DESCRIBE WORK
8. C° b la 0
VALUATION
9.
Utilities
PS(
urce GAS / ELECTRIC
of �//
tilities
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 regu a 'ng construction or the
performance of construction.
DATE
erg -71
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/ /YL B e_l _
DATE IZ"I'/"! / OFFICIALU7fQrGe
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. Z�
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /Z- v -d
DATE
G
PERMIT NUMBER
79-7138
6-179
04* *1200
*1200 175
*12000
E *000
9187
12-17=79
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12- a 7=79
918.82
*12.0.0°
1r.