1979, 12-18 Permit: G79-9224 Conversion BurnerPLAN 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
2�a
LOT BLOCK SUBDIVI ON
LEGAL DESCRIPTION - SEE ATTACHED
3.
OW
PHONE
PARCEL NUMBER/S
ADDRESS
� �u
ZIP
Required Set Backs in Feet
North 'South East (West
CONT CTOR
4.'F 1ti� ri.
ADDRESSOi c
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TO
as -c5
PHONE
4 -24 -4o -ib
ZIP
PHONE
ZIP
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area
TYPE
7. OF
WORK
❑ NEW LTALT. 0 AD'N.�0 RPL. 0 MVE.
❑ BLD. 0 PLMB. lE MECH: 0 M.H. 0 POOL
DESCRIBE�K1
8.
VALUATIO
9.
eom
Source
of
Utilities
0 OTHER
�sr�tJ \001,,APY'
GAS
ELECTRIC
Split Entry
No. Baths
Split Level
Storage
Rancher
No. Floors No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
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 construc "on or the
performance of construction.
DATE 9-( l'1 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITL NS:
/er6 /37 a S.P
DATE /L'f '7 OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
IZ,
TOTAL $ /1 075
Z.
DATE
G
PERMIT NUMBER
-
04* *12,00
* 1200
* 12.006
E *000
92232
12-18-79
2 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COM APERM IT.
12Ll —77'9 9'2.2.42 *120,02