1979, 08-20 Permit: G79-2471 Natural GasPLAN NUMBER APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
OWNER
3, J e I+N 14
ADDRESS
1�3sLI E•
CONTRACTOR
4. ADDRESS
DESIGNER
5. ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES.
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVIbIUN 5 PARCEL NUMBER/S
CHANGE OF USE FROM
6.
PHONE
z lq
PHONE
ZIP
PHONE
ZIP
2equired Set Backs in Feet
Jorth South
East I West VX I
tize of Parcel
Zone Classification
Type CoT7
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
/aluation
Building Area in Sq. Ft.
DWL Area
Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
• TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF,, / ❑ OTHER
❑ BLD. ❑ PLMB. ECH: ❑ M. H. ❑POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
FEES COLLECTED
8. G
3 D
VALUATION
Source GAS
WATER
SEWER
. e
of
9,
Utilities
Single $
I hereby certify, that I have read and examined this application and have read the "NOTICE" provisions included
onreverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
Building
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.
Plumbing
SIGNATURE
Z/ -DO
DATE
Mech. ' dK_
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall Vis,
Co. Engineer
Other (Specify)
Utilities
TOTA L $
Zone Clearance
WHEN MACHINE VALIDAI
THIS BECOMES A PERMIT.
SEPA Checklist
T
DATE OFFICIAL
[1
7
APPROVED FOR ISSUANCE
PERMIT NUMBER
6 -79 — z liltJ71
DATE A ( 20�IRi
0.4* *4.00
*400
*&0083
B *000
24.70
0.8-20-7.9
a 6479.
THIS SPACE,
2 4;Z. 1 z