1979, 11-02 Permit: 79-7194 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (5091 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1.
2.
3.
LOT
BLOCK
8 6 HAW
SUB IVISI
ral& DESCRIPTION — SEE ATTACHED
OWNER
PHONE
Clan -a605-
PARCEL NUMBER/S
ADDRESS
87oce F. tiAt2IAia •Talo
CONTRACTOR
ZIP
4. a -C 1.I (Au Cl' /Al .
5.
ADDRESS
3003 M • CSP rt /ub sPP -a,=
DESIGNER
ADDRESS
AC q43ctr,
PHONE
ZIP
MYp-O9
PHONE
ZIP
Required Set Backs in Feet
North 'South [East 'West
Size of Parcel - Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
0f l_
TO
AS•
Split Entry
Split Level
Rancher
NEW
0 BLD.
❑ ALT.
❑ PLMB
❑ AD N.
• MECH
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
L°#AAlG,= ou�-
VALUATION
9.
6J �>L°�AC� TO C°el-S FUf2 a�iA-�c
Source
of
Utilities
GAS 1 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 y gyp, al law lati cons, ruction or the
performance of constrpction.
DATE
DEPT.
SPECIAL APPROVALS
REO'D. RECD.
SIGNATUR
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
lov yh t3 -c)
DATE 415-2-74, OFFICIAL R-414.-Lt�P31 /
FEES COLLECTED
Single $
Building
Plumbing
wy
McGi.
Plan Check
SEPA
Mobile Home
3 .
.0-0
pecify)
TOTAL $ ��•�—
DATE
if 1PERMIT NUMBtB ig I
it'
04* *1200
*1200 V)
719.32
11-024-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. o * 1 �' o O a H
1'11-402'-7i9 719.4=
•
APPROVED FOR ISSUANCE —