1979, 12-13 Permit: 79-9050 BurnerPLAN 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
JO ADDRESS
1. � lONit
O
BLS0
CK iSUB IVISItJN
2.
OWNER
3 • W t& PD Ph -(e.
ADDRESSZIP
LEGAL DESCRIPTION - SEE ATTACHED
CONTRACTQR
ADDRESS
N ( 21303 ejte jf me
DESIGNER
4- AA t%9 i (iv.(
5' ADDRESS
PHONE
1$gs�rO
enxn c„
PHONE
''fiy - Lf0 74.
PARCEL NUMBER/S
Required Set Backs In Feet
North 'South jEast (West
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Oyes ONo 0 Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
D W L Area
Basement Area 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
0 NEW in ALT. 0 AD N. 0 RPL. 0 MVE.
❑
BLO. 0 PLMB. (*MECH: 0 M.H. 0 POOL
•
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
. DESCRIBE WORK �r'(�/`
8. Sta u ce9fi Eric?. (cr>mc.cot^ytP.i"
VALUATION I Source Ir GAS ELECTkkIC I WATER SEWER
of
9. Utilities
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 cons ruction.
DATE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA-Checklist
SPECIAL CONDITIONS:
er/Wretk4ty a-4/1)
irrm PTO
i3-79
DATE 0FF1 CIA' / '7✓t/LtC
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. I / 471.12 -
Plan DD
Plan Check
SEPA •
Mobile Home
Other (Specify)
00
TOTAL $
DATE
04* *14.00
* 1400 N
* 14006
E *000 8
9049.
12-13-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
2=4.'3'-;7'91 905.0=
*'1 4 0 01..p3
0
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N