1979, 09-12 Permit: 79-3854 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
JOB ADDRESS
/- �()C
LOC
Z. SUBDIPZANe IG//y,I J
Up)
LOT
3
OWN
LEGAL DESCRIPTION - SEE ATTACHED
R
3. /V/Arf ,46e 5
ESS /x/ y
/CO 0 M4 t o eJ/
PHONE
a Ig-57a(e
PARCEL NUMBER'S
ZIP
4'4266,
Required Set Backs in Feet
North 'South East (West
4.
CONTRACTOR
S.a e
ADDRESS
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes DNo 0 Req'd.
5.
DESIGNER
PHONE
Valuation (Building Area In Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
❑ NEW
❑ BLD.
O ALT.
❑ PLMB.
❑ AD N.
❑ MECH:
❑ RPL.
❑ M.H.
0 MVE.
0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORT r
8.
.4() ctC q o' (` learp6
le '' ',Q Noce
VALUA ION . 0 I_ Source GAS ELECTRIC
of
9. • Utilities
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
performance of�p
construction.
DATE (-17-7 't SIGNATURE
/egulating construction or the
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
APP"0 % OR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
'? 00
Mech. `'
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
(a4
PERMIT NUMBER
-77 - 3,954
DATE
04* *7.00
*7.00
*7.008
A *aoo 8
38531
09-12'-79
2 6479.
MIM
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
3'85.45 *7,133 PI-