1979, 10-22 Permit: 79-6462 FireplacePLAN 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 Az
LOT
OWNER
BLOCK
ADDRESS
iao/4' 4.
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PHONrEE 1/4
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East 'West
.CONTRACTOR
4. ADDRESS
PHONE
Size of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB
❑ AD N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTR
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
performance of construction. .
DATE SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE/ / OAF IA
APPRO
FEES SOLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
M
�ai Jam, /779
PERMIT NUMB R
79 /6�
04* *7.00
*7.00 Di
*7.008
E *Q00 8
6461A
10-22-79
£ 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BCOMES A PE.RMIT.
1Q :22'u:79 6'i46:t2Z. *7.0„0.2
FOR ISSUANCE _
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