1979, 09-14 Permit: 79-4030 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 a u/ `•' c
1 LOT BLOCK SUOBD7VISION B O ~ a' J n
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
O NER
3 veritfse Pa.A I q ten
ADDRESS O
N /n 5K,pwo h.
CONTRACTOR
4 A/DYa-e /t ea f- fit" (?ESSA
DR5O S/ "7-.--e--71.1- ,4 v °
DESIGNER
5.
926=7a7'/
ggach
Required Set Backs in Feet
North 'South East 'West
3`l -i/f/
ize of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Vas ❑No 0 Req'd.
PHONE
Valuation
Building Area In Sq. Ft.
ADDRESS
ZIP
OWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE 0 NEW 0 ALT.
7, OF
WORK � BLD:— "- 0 PCMB.
❑ AD N.
$MEC Hi
O RPL.
O M.H.
❑ MVE.
O POOL'
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
---CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
$' j.n9friar /[ Gita F cc.rnact- 137,00a
VALUATION
9.
Source
of
Utilities
GAS
x
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this applica ion and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correc . 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 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./0st
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ &a°
A
PERMIT NUMBER
79- .yioc-5d
DATE 1/2 7 /7 y
04* *1200
* 1200 h
* 12000
• E *a00 8
40292
09-14.79
.R 6479.
MINIM
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Q 9479 4 0''3.0 = *. 1.2 0 0 a.