1979, 11-19 Permit: 79-8026 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
JOB ADD�S�
.\-
BLOCK SUBDIVISION
LOT
LEGAL DESCRIPTION — SEE ATTACHED
3.
OWNER
ADDRESS
C ;-4t Jz
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East
West
4.
CONTRACTOR
l 'i NG
PHONE
Size of Parcel
Zone Classification
ADDRESS
))L\(;) 5 Ci AA kJ L.
DESIGNER
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW L'7 ALT. ^❑ AD'N. ❑ RPL. ❑ MVE.
E
❑ BLD. ❑ PLMB. fr/ECH: ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
Eve Ai kg -lo
i -c
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 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 10 �l SIGNATURE � �
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
?21Jtq\i1
DATE OFFICIAL
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
(C)
DATE 1 /�-yy V ._. 19
PERMIT NUMBER
04*
02,5.1
11-19-79
679.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
60 *14;;,`