1979, 11-26 Permit: 79-8349 FurnaceLAN 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;; 7�DDRESS
LOT/I \BLOCK
2.
SUBDIVISION
3
OWNE
ADORES
CONTRAA✓/7/,
4. ADDR 'SS 4,
'#o'/
us
DESIGNER
5.
PHON
ZIP
P ONE
mss- (Ko S
ZIP //"te
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs In Feet
North 'South lEast `West
Size of Parcel - I Zone Classification
Type Const.
Occupancy Sprinklered
Oyes DNo D Req'd.
PHONE
Valuation (Building Area In Sq. Ft.
ADDRESS
ZIP
OWL Area 'Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE 0 NEW
7. OF
WORK 0 BLD.
DCRIBE WK ORI
8. 11
VALUATION
9.
O ALT.
O PLMB
ro AD N.
IKMECH:
❑ RPL.
D M.H.
Sp{/rce
of •
Utilities
X
O MVE.
O POOL
0 OTHER
ELECTRIC,
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
sed P., / o, aa.)
WATER
SEWER
Req'd.
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 oft/ construction.. ��[/� \/
DATE � /// % SIGNATURL•„Lc /�7"�'-"-'
SPECI L • •NDITIONS:
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Recd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
' es
DATE
04* *1200
*,1200 N
*12o -0U
B *000 S
8348`
1 1 -26'-79
6479.
�fRi _
P' Pi 0'9
riot a '2
Other (Specify)
Utilities
Zone Clearance
SEPA Checklist
TOTAL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE411, OFFICIAL C2.22444-7t� ll,l `12 U '�l"' 8 3 49 z *112 8.8'9 H
APPROVED FOR ISSUANCE