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1979, 08-16 Permit: 79-2323 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 ADDF LOT 2. TBLy�rSU/� ISION I 3. OWNEp, /� ADDRESS / (?6 —5?57a LEGAL DESCRIPTION - SEE ATTACHED PARCEL NUMBER/S ZI p Required Set Backs in Feet 4. CONTRric TOR ADDRESS S®63 . DESIGNER ADDRESS 6. CHANGE OF„USE FROM V �L TYPE 7. OF WORK PHONE 2k4 ---407b ZI P PHONE ZI P TO Le NEW R<T. D AD'N. ❑ RPL. ❑ MVE. ❑ BLD. ❑ PLMB. IG MECH: ❑ M.H. ❑ POOL ❑ OTHER DESCRIBE WORK VALUATION 9. Source of Utilities GAS yvei ELECTRIC North South East Wes Size of Parcel Type Const. Occupancy Zone Classification Sprinklered ❑Yes ❑No ❑ Req'd. Valuation DWL Area Basement Area Split Entry No. Baths Building Area in Sq. Ft. Garage Area Split Level No. Floors CERTIFICATE of EXEMPTION UWATER Storage Rancher No. Rooms 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. j DATE lam' IctiCt SIGNATURE DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CON ONS: 8bnTh 4 DATE 1G- OFFICIALf-1141 Req'd APPROVED FOR ISSUANCE Rec. Room Recd. Not Req'd. FEES COLLECTED Single $ Building Plumbing Mech. ^ / c , 6-0 Plan Check SEPA Mobile Home Other (Specify) TOTAL $ 12.0E DATE PERMIT NUMBER /1-z z: 04* *1200 *1200 N *12006 B *0,00 0 2322 08-16-79 6479, WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMESA PERMIT. 0 8 -1 -79 23235 *120 0 0-