1979, 11-14 Permit: 79-7787 FireplacePLAN 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
,.-h 2air
LOT BLOCK SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
OW
ADDRESS
PHONE
Z y._ 5' »7,
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East 'West
NTRACTOR > �%
4
. CZHG/ „4,--- ( KL
DDRESS / .
2J/ 1'#i (D..,...4uc#C
PHONE
liti'/G /'
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Oyes ❑No 0 Req'd.
5.
DESIGNER
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area 1 Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ 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.
Re 'd.
Not Req'd.
C
t�/ifi�1 .iter.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this applica ion 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 _ __ '. SIGNATURES."-//.tr`u"---
DEPT.
t SPECIAL APPROVALS
f REO'D. RECD.
I
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
• SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
ec
"1r
Plan Check
SEPA .
Mobile Horne
Other (Specify)
TOTAL $ f
! - 1
PERMIT NUMBER
7/ -� 7
DATE
04* *700
*7.00
*7.006p 8
B *000
77868
1i1-14-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COMES AP MIT.
'l'�.t a 4 709 778, 7z
A7.00,a°�