1979, 11-02 Permit: M79-7204 FireplacePLAN 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
1002,
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
3. OILIAANl
ADDRESS
C OJA C„TR
4. ADDRESS
ZONE 1
0 ~ 5S3.z.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
LJ NEW ❑ ALT.
❑ BLD. ❑ PLMB.
Z1P
PHONE
ZI P
PHONE
ZIP
TO
❑ AD'N.
❑ RPL.
MECH: ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
Required Set Backs in Feet
North (South
East
West
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
Valuation
DWL Area 1 Basement Area
Building Area in Sq. Ft.
Garage Area
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
9.
DE C B WORK� Source
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. %
DATE %47` 77 SIGNATURE7...��Air ••
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE r/!
ED FOR ISSUANCE
4
FEES COLLECTED
Single $
Building
Plumbing
Mech,
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
C4*
* 7.00
* 7.0 0 t5
720.38
11-02-79
g 6479.
t
WHEN MACHINE VALIDATED IN THIS SPACE,
THISIBIC011OIF,$I— RE,RMIT. 7 2 0.4
* 7.0 0 T. III