1979, 07-19 Permit: 79-783 FurnacePtAN NUMBER
APPLICATISI/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.
JOB ADDRESS `/
G /6 7.9 iY &,Ply Sl
LOT ll BLOCK c�,
SUBDIVISI
LEGAL DESCRIPTION - SEE ATTACHED
3.
O
EEAf/E /t6,a -5
PHONE
97S'td90
PARCEL NUMBER/S
AD/GRRESj$y
1'✓` tw I
,V4', -o C Wiry
CTRACTOR
OR m , QrnLITy' OTC.
4'
ADDRESS.
erz-7ic / An) 1fN Pt -
Required Set Backs in Feet
North (South East (West
PHONE
y��oo
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
DESIGNER
6. ADDRESS
PHONE
Valuation
Building Area In Sq. Ft.
ZIP
OWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO'
Split Entry
Split Level
Rancher
TYPE eNEW 0 ALT.
7. OF r❑vA-,D N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. 161' MECH. 0 M.H. 0 POOL
WORK (ELFc FuRN Doc -r)
'tw , w/ c-,
VALUATION ELECTRIC
8. p�SC RIB- WO />
9.
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
Source
of
Utilities
GAS
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
Derforma•,nce of construction.
DATE �/6 - SIGNATUREE n- lat
-Gv+.1
DEPT.
• SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE ?f I •/ ' ' OFFI
APPROVEDFOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
1p ex.T
Mech.
oo
Plan Check
SEPA
Mobile Horne
re rat
T
3,00
Other (Specify)
TOTAL $ 70C
PERMIT NUMBER
7o-3
DATE
• 04*
A
7a2a
07-19=79
a 6479.
*7.00
*7.00
*7.006
*000 8
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07',197,9
78.3z
*7,00°1.
C
O
W
0
h