1979, 12-13 Permit: 79-9038 FurnaceIPLAN 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 ADDRESS
1. S' /
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
3.
OWNER
ADDRESS
PHONE
%„z/ --fa79
,G // 7Ai 06/0.... -Gni P 4:,it:.,) ,e,,e - e
CONTRACTOR 1J
4. 4 f/Gf Qk 4 /. /ty ,L/ %44,9 lr/�. »1
ADDRESS %/ 7/
C� 7/
/ a /4-‘,/,€A,;€ / spe xc'^f� P,, 44Q
5.
6.
ZIP
/4.-e
PHONE
9frt vz/OC)
Required Set Backs in Feet
North South (East 'West
Size of Parcel 1 Zone Classification
DESIGNER
ADDRESS
ZIP
97A /G
Type Const.
Occupancy
PHONE
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
CHANGE OF USE FROM
ZIP
DWL Area
Basement Area r Garage Area
Storage
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
9.
NEW
0 BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
Al.( .tile' Y'
Source
of
Utilities
GAS
ELECTRIC
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 /.2 -// — 7y SIGNATURE e�
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DAT
OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
3, c'!u
y. as
SEPA
Mobile Home
Other (Specify)
TOTAL
$ vei
PERMIT NUMBER
-q0-5.5
DATE
DATE
04* *7,00
*7.00 17)
*7.006
E *Q00 8
90378
12-13-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS
BECOMES A PERMIT.
12-,1. ,_7:903.82
*,7,00°-1