1979, 10-01 Permit: 79-4987 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 ADDRESS
-5-S err 77//77/771.1.'"1—/LOT :LOCK SUBDIVISION
2.
‘LEG4 DESCRIPTION - SEE ATTACHED
OWNER
3- �/ - /ii� y,(��1/"1•'� f
CONTRA[ OR
4.
ADDRESS
1-�
DESIGNER
ADDR S5
PHONE
.53920 7
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South (East 'West
5.
PHONE
Size of Parcel l Zone Classification
zip 7
Type Const.
Occupancy
Sprinklered
Oyes ❑No 0 Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6. �/
TYPE Y�NEW
7. OF
WORK ❑BLD.
DES IBE WO
& r
V - LUATION
9.
TO
Split Entry
Split Level
Rancher
Vd ALT. 0/9D N. 0 RPL. ❑ M V E.
❑ PLMB. L^J MECH; 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
/
Req'd.
Source
of
Utilities
!A�
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this applica ion 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 anyother state -or local law regulating construction or the
performance of construction.
/ /'
DATE '� -‘7.g SIGNATOR
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL ONDITIONS:
DATE%—af 79OFFICIAI. _Lc yam'
APPROVED FOR ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing / ry
Mech. / a9
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /V
PERMIT NUMBER
79-4/4 27
DATE —/
04*
*1200
*1200
*12006
E *000 8
49868
10-01-79
6479,
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'0!- 0 V7.7i9 4.9 8, 7 z
*120ILI
cc
0
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UJ
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