1979, 10-12 Permit: 79-5908 FurnacePLAN 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
LEGAL DESCRIPTION - SEE ATTACHED
JOB ADDRESS
1.
1y60
LOT BLOCK SUB IVISIO
OWNER r
2.
3.
ADDRESS
aYY ey y o w nor
cf,117-7770
PARCEL NUMBER/S
C
NTRACTOR
0
ADDRESS
- s oS/ 7 -•e-nt its
DESIGNER
5' ADDRESS
q7.1r6
Required Set Backs in Feet
North 'South
East
'West
ONE -
3`/-119175
9 �z0-d .
Size of Parcel •
Type Const.
Occupancy
Zone Classification .
Sprinklered
:Wes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
OWL Area I Basement Area r Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
o ALT.
❑ PLMB.
❑ AD N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
C POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
R eq'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. Sn 5fa- ft ,(e.n n07cJ/ eef,-f e P r.na
WATER
9.
VALUATION
Source
of
Utilities
GAS
ELECT R
SEWER
I hereby certify that I have read and examined this appllca 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
DEPT.
SPECIAL APPROVALS
REO'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE I V7`If 77 OFFICI
APP eV i.FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
•
Mech. 7/
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
.na.
PERMIT NUMBER
19-570,5
DATE
04* *700
*7.00 N
*i7006
B *QOO 8
59Q72
.16;12,-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
5'90.8 *7,0L0°�.
0
U
W
CL.
z