1979, 10-19 Permit: 79-6365 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
LOT
BLOCK
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
S BDIP7ON
3.
OWNER
ADDRESS
71.5
CONTRA OR
4.
7e %
et�
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
9.
D NEW
O BLD.
DESCRIBE WORK
VALUATION
PHONE
ZIP
�yo6-
PPHH�NE
PHONE
ZIP
TO
O ALT. 0 AD N. ❑ RPL. 0 MVE.
❑ PLMB. ,MECH: ❑ M.H. 0 POOL
Sour.
of
Utilities
GAS
❑ OTHER
ELECTRIC
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in
North
Feet
South East
Size of Parcel
Type Const.
Occupancy
Basement Area
Split Entry
No. Baths
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
CERTIFICATE
of EXEMPTION
J 74
WATER SEWER
No. Rooms
Storage
Rancher
Rec. Room
Req'd. Rec'd
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 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
/0/,9
OFFI
APPR'"' i FOR ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
bp_
DATE
PERMIT NUMBER
04* * 1 1.00
* 1 1.00
* 1 1,006
E *0.00
63648
10-1,9-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BE OM S P RIT.
'I
1U -19-7j 9 6'36.,52 *11,002