1979, 08-14 Permit: 74-2120 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
1.
2.
OWNER Lida/
3 �r// (mak'f ye4.
ADDRESS /
/V ao z 'osso /4.�.�,
CONTRACTOR
4. / fiV c A Iy N"u /(
JOB ADDRESS
/V. i 020
LOT
I3ow445ii
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
PARCEL NUMBER/S
5.
ADDRESS
/® �nv�i fc,�.tt� S�4dF-ccvP 4,4DESIGNER
PHONE
9aE pWat
z3
7aQ6
PHONE
ya t -02Mo
Required Set Backs in Feet
North 'South
Size of Parcel
East
(West
Zone Classification
ZIP �a /r7
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
Valuation
Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area
Split Entry
Split Level
Storage
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
LteALT. 0 AD'N. ❑ RPL. 0 MVE.
0 PLMB.
H MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK %
$ /.4-S' is ,/Gt''Cs'Pt e
/ K R //L? C e
VALUATION
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 local law regulating construction or the
performance�of construction.
s
DATE I — 7 / SIGNATUR
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS
To, wa f? z( / I �'%�. C lr Cis A
DATE
3
It/ e
FEES COLLECTED
Single $
Building
Plumbing
Mech.
00
,p,e j)&U
r PIA Check
SEPA
Mobile Home
Other (Specify)
oG
TOTAL $ 275 f OG7
DATE
PERMIT NUMBER
-210
04/* / Z 2.00
* 1200 u,
* 12006
A *0.00 n
211.92
08-14-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0871'4-79
•
212.0g *1200