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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 C-)1-•• W 1 Z