1979, 10-31 Permit: 79-7045 Fuel DamperPLAN 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
1.
2.
3
4.
JOB ADDRESS
LOT
BLOCK
//o,?/ ,?3/4.,"
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIVISION
OWNER
ADDRESS
CONTRACTOR
.94 712
AD f /
DESIGNER
5. ADDRESS
%/o
PHONE
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North South East 'West
PHONE
ZIP
Valuation
DWL Area
Zone Classification
Sprinklered
❑Yes No 0 Req'd.
Building Area in Sq. Ft.
Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
TO
❑ NEW
O BLD.
DESCRIBE WORK
O ALT. 0 AD N. ❑ RPL.
i
O PLMB. `%V�iy- ❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Split Entry
No. Baths
Split Level
Rancher
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
VALUATION
9.
Source
of
Utilities
GAS
EL TRIC
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 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/0—c3/-1
DATE OFFICIAI R.00��////��
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mec,atz
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
-7e4-5"
DATE
DATE lyz 3(/f,/
04* *7.00
*7,00 r
*7.006
B
*000 0
70442
10-31-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 57'719 70'4.5g
* 7. 0 0 °a1_
APPROVED FOR ISSUANCE —