1979, 12-10 Permit: 79-8858 FurnacePLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
�M PERMIT NUMBER
DATE
07
CHANGE OF USE FROM TO Split Entry Split Level Rancher
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JO ADDRESS
No. Baths No. Floors
TYPE X NEW El ALT. 1-1AWN.ElRPL. ❑ MVE.
No. Rooms Rec. Room
LEGAL DESCRIPTION — SEE ATTACHED
7, OF ❑ OTHER
LOT
BLOCK
SUBDIVISION
Req'd. I Recd. Not Req'd.
PARCEL NUMBER/S
2.
I
DESCRIBE WORK8.
FEES COLLECTED
VALUATION Source GAS ELEWA R SEWER
//C
7
3.
WNER
L— WR
PHONE
ADI514ESSZIP
L] �V
2 r,-�
4
g!? t'-3
Required Set Backs in Feet
North South East West
4.
ONTRACTORPFIONE
Q),UA L (4 LE C-
qp�'
Size of Parcel
Zone Classification
ADDRESS
(
/T� y
..L— ��/ N
ZIIPP' i /
1 9 �+��fCj
Type Const.
Occupancy
Sprinklered
❑Yes [-]No ❑ Req'd.
DESIGNER
,�--�-1
PHONE
Valuation
Building Area in Sq. Ft.
5'
SPECIALAPPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
ADDRESS
Env. Health
ZIP
OWL Area
Basement Area
Garage Area
Storage
�M PERMIT NUMBER
DATE
07
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors
TYPE X NEW El ALT. 1-1AWN.ElRPL. ❑ MVE.
No. Rooms Rec. Room
7, OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. KMECH: ❑ M.H. ❑ POOL CERTIFICATE
Req'd. I Recd. Not Req'd.
of EXEMPTION
DESCRIBE WORK8.
FEES COLLECTED
VALUATION Source GAS ELEWA R SEWER
//C
7
Glr
I`TRIC
9. Utoties t&) 2-"
Single $
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
Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
egulating construction or the
to give authority to violate or cancel the provisions of any other stlz::�
performance of construction.
Plumbing
�� -
'� -�
,�--�-1
DATE / SIGNATURE
Mech.
SPECIALAPPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
F
Fire Marshall
Mobile Home
c
Co. Engineer
Other (Specify)
t7)
UtilitiesI`�y?JTOTAL
$ �"�-
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
/.
J 0
/. l)
DATE�� 7 OFFICIAL