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-