1979, 11-27 Permit: 79-8394 Gas PipingPLAN 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.
JOB ADDRESS J
,E ' io so'/ 7-/o /ma A) Pc .
LOT BLOCK
SUBDIVISION
LEGAL DESC-WIPTION - SEE ATTACHED_
PARCEL NUMBER/S
OWNER
-J e Lia y [eE_. - -
ADDRESS
,E. /nr5o� Alo/ma,o k
CONTRACTOR / r d&
4. aJ
ADDRESS �+
N• Joos 0111
DESIGNER
5. ADDRESS
PHONE
ZIP
Required Set Backs in Feet
North !South
East
'West
PHONE
49,207 •
PHONE
Size of Parcel - - -- . I Zone Classification
Type Const.
Occupancy
Sprinklered
Oyes ONo E Req'd.
Valuation - I Building Area i Sq. Ft.
ZIP
D W L Area
Basement Area 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO •
Split Entry
Split Level
Rancher
Iii NEW ❑ ALT.❑✓ AD N. 0 RPL. ❑ MVE.
0 E BLD. 0 PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
--Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK AS P 1Plam1
a _I_n_siadi "f- hrok (2..pP
/-L.g
VALUATION Source
of
9. utilities
)
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this application 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�/co struction. /��,/'/�� . ///'J y///,� ,{%/%
DATE i//`�7�79 SIGNATURF 2L-«G2L_, 46 /-0&
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
• SPECIAL CONDITIONS: -
02 07, ant iSTu.
GE P06- 79ot
//- 'Z. 7- 7'7
DATE OFFICIAL Rai a tia.4"c -'Z.
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
PERMIT NUMBER
7 9-3'39`f
DATE /*//f %/i%
a oa
•
Mobile Home
Other (Specify)
TOTAL
04*
*.1200
*12.00
*12000
E *000
839.3 --
11 -27'-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'1' -2.T -,7i91 8'3 9.4 z *:12, 0 01.{1