1979, 09-21 Permit: 79-4505 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. F $6 /5- /%aLot-
�..�
2.
OWNS /
3. TO/ N SG/o2/v/r4
ADDRESS
4E_VC- 6/C4
� / - /Ala/.-.-,5oe, -ve 4'a
4. ADpRESSfre
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DESIGNER
BLOCK
SUBDIVISION
/4.T.
LEGAL --,DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
PHONE
qa6 —67o3
ZIP
79o%O‘,
Required Set Backs in Feet
North 'South East 'West
5.
PHONE
Pa g"—.2/ao
Size of Parcel 1 Zone Classification
ZI P
97a /G
Type Const.
Occupancy
Spnnklered
Oyes ONo 0 Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ADDRESS
ZIP
OWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Split Entry
Split Level
Rancher
O NEW
O BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH:
❑ RPL.
O 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 /,v•rrec/ Gas t i#s(— ce.
VALUATION
9.
Source
of
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 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
performance of construction.
DATE 7 -/ $ - 79 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS: l/
2j '—/ Ji .J/
J /
tpt/ YojZ-ic `' /Oa, aOC 'TGC
a S %-Naf-AAO r
DATE /-1-7/OFFI C IAVJdS6r"� "fir'✓
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
P%PB
Plan Check
SEPA
Mobile Home
Other (Specify)
yoo
G, o !J
TOTAL s,QC �G
N
PERMIT NUMBER
79 -,1SoS
DATE 9-..Z1 -79
04* *1200
* 1200 17)
* 12008
E *Q00 0
45Q42
09-21-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BCOMES A PERMIT.
09:H21.9- 7.9 4.5 0,5 2 * 1.2 0 0; 2.
CC
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