1979, 12-20 Permit: 79-9368 Conversion BurnerPLAN NUMBER
APPLICATION/PERMIT ,
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPS OKtA NNE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS -�
1. / `i l 7 fl2C /JON&JC)
LOT BLOCK SUBDIVISI N
2. -
OWNER
3 h -ppD/ CiO
ADDRESS
6 (J4fl
CONTRACTOR. - - •
4. 6-4 /-L ficiarmiq
ADDRESS 3 Cit p
DESIGNER
5.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
ZIP
Required Set Backs in Feet
North 'South East 'West
PHONE -
42"J- 5!078
Size of Parcel - 1 Zone Classification -
ZIP
Type Const.
Occupancy Sprinklered
0Y -es ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq..Ft.
•
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF U E FROM
6.
TYPE L7 N
- EW 0 ALT.
7, OF
WORK BLD. 0 PLMB
TO .
0 AD N. 0 RPL. 0 MVE.
C1 MECH:v1.H. 0 POOL
0 OTHER
SPIIt Entry
No. Baths
Split Level
No. Floors
No. Rooms
Rancher
Rec. Room
CERTIFICATE-
af EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WOR
8. z.,—all a aa4 t&4tueis -c bt,theo . -(aA_ )
VALUATION Souu/ G2, ELECTRIC WATER SEWE
9. - Utilities
V/
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 co truction. j//�/l, (/�/�/J,f
y F�X.C-/.-1t-rLLC'd-d
DATE ��- �iU7 �� / SIGNATOR ban
-e
SP EC IAL'APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fite Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS: •
/UOrYc 5-11-C
/;)
DATE OFFICIALR.1 ( '42J 441Ai1/A;7,(41
FEES COLLECTED -
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /2
PERMIT NUMBER
G 7g-q3&g
DATE /o2 -1O"7/
04* *1200
*1200 L
*12006
8 *Q00 8
93672
12-20-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
:i 2 x,7:0:: 7i91 9'3 6.`8 5
APPROVED FOR ISSUANCE _
*:12oloa;-E2