1979, 10-12 Permit: 79-5887 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
1.
2.
3.
JOB ADDRESS
LOT NL?I EfUBDMN
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
cJAet( IAred( 01
ADDRESS
Savvy Q_
PHON
42(o E 13(0 i5
ZIP
PARCEL NUMBER/S
Requ red Set Backs in Feet
North 'South [East 'West
CONTRACZOR
ADDRESS
1 , \ W t4-3 L
PHONE
4434-4076
Size of Parcel
Zone Classification
ZIP
Type Cons
Occupancy
Sprinklered
Oyes DNo D Req
DESIGNER
PHONE
Valuation
Building Area in Sq. F
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6. C'Il
TO
Split Entry
Split Level
Ranche
TYPE
7. OF
WORK
•
❑ NEW 0r-�� AD N. 0 RPL. D MVE.
❑ BLD. D PLMB. tdiviSLECH: D M.H. 0 POOL
0 OTHER
No. Bath
No. Floors
No. Room
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd
Not Req'd.
DESCRIBE WO
8. Tn35 L� Colve>Isu J J'live✓
VALUATION Source I GAS ELECTRIC
of
9. Utilities
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 correc . 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
tAS—
performance (of-
f construction.
'O
DATE -7-1QZ9 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITI
foo BT(,(,
•
DATE/Q-12-79OFFICIAL42, neat "eW
APPROVED FOR ISSUANCE
FEES COLLECTED -
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /OS
G
PERMIT NUMBER
7t -sfa7
DATE 7—(Q -"Lc'
04* *12'00
* 1200 6-
* 12006p
B *D00
5588.628
10-12=79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1017a1 2L7'9. -518 8.7 z
*120,0ar!
C
0
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W
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