1979, 10-12 Permit: G79-5840 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS 7
i
LOT
OWNER
3.
ADDRESS
BLOCK
UBDIVISION
CONT,' �/ TOR /
//
ES
••S
O.
DESIGNER
G%ir 0793,
ZIP
'-
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South 'East 'West
5' ADDRESS
PHONE
PHONE
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
DESCRIBE WORK
❑ ALT.
❑ PLMB.
,Z{AD N. 0 RPL.
SJ MECH: 0 M.H.
❑ MVE.
O POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
VALUATION
9.
Source
of
Utilities
'yA5
XX
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 l .I law regulatip construction or the
performance of construction.
DATE /t/ — $/- 9/ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
�
DATE`jj Q/ 1 /f
5kOFF IAL ^^
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
/-Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
— ✓g
DATE/G' - 1-97
04*
* 1 2 0 0
* 1 2 0 0
*0.1 2J
* 1200
E *012 0
5839f.
10-12-79
64 7 9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B CO A MIT.
1U—.1? —/9 58400;
*12.00
INSPF(:TOR