1979, 08-15 Permit: 79-2212 FurnaceP1.1AN NUMBER
r
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.
3.
4.
JOB ADDS
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
OWNER\ �_ j.
ADDRESS \\\�(j� /�
1.., d 0/'� Y [ .� • l n A
CONTRACTOR
Cc' 1 .sum V r
ADDRS
k s7-0,sz_SLo
DESIGNER
5' ADDRESS
PHONE
ZIP CI
/
'1 CI d 50
Required Set Backs in Feet
North (South East 'West
PHONE
47Ct -(1581
ZIP
ckct acls
PHONE
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
Dyes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZI P
DWL Area
IBasement Area Garage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
TA NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. VY`�pici
Vl� �QQd. L
VALUATION Source ELECTRI
of
9. Utilities
T1 rv\ t',.f 9
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 authqey 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:
DAT
‚4
v
A"'!' D FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
)4. 00
Other (Specify) 3.00
� n
TOTAL $ r 0
PERMIT NUMBER
—22[Z
DATE
04*
A
221,12
08-15-79
2 6479.
*7.00
*7,00 N
*7.006
*000
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS013gC_OnS A,QF,�MIT. 2 2 12 o
*7,0 o a