1979, 11-09 Permit: 79-7585 FireplacePLAN NUMBER
APPLICATIOO 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
JOB ADDRE1-7SS
1 / IJV O
LOT
BLOCK SUBDIVIS ON
ROA()
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Ml ,r c ' l J"'ll
ADD OPLL 52't2-17 cARArJ POAO
P4
Required Set Backs in Feet
North - 'South East (West
CONTRACTpR
PHONE
Size of Parcel
Zone Classification
ADDRESS
ZIP
Type Con
Occupancy
Sprinklered
❑Yes ONo ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry Split Level
Ranche
TYPE
7. OF
WORK
IE EW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. LJ/MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd
Recd
Not Reg d.
8. DEARIBT, WOR Ivz ft r1-/�
VALUATION Source GAS
of
9. Utilities
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examinedthis application and have read the "NOTICE",provisions included
on reverse side,5nd 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.ru
*?"-/
GATE //— 7 SIGNATURE
DEPT.
SPECIAL APPROVALS
REO'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilitie
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
7� — 7s g;
DATE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11/,049,7i9i 75&52 *,zoa