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1979, 10-09 Permit: 79-5555 FireplaceLAN NUMBER APPLICATION/PERMIT SPOKANE COUNTY — BUILDING CODES DEPARTMENT NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (609) 456-3675 - APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES JQB ADDRESS L.— (—iv , LOT BLOCK SUB IVIS ON 2. LEGAL DESCRIPTION — SEE ATTACHED PARCEL NUMBER/S OWN 3. Ate. ,4 .,.?,PA, to- ADDRES5 f°, /voal -7/444 COIN -FACTOR i 4. ADDRESS / t tf y.� � .L? f�. /rS h or (fe .4j kl-V.!I/i-c- itc. DESIGNER 5. PHONE 9 £4,-S 7.5 3 ZIP 99.Zoi Required Set Backs in Feet North (South (East (West PHONE' 1-69# 6' Size of Parcel 1 Zone Classification ZIP Type Const. Occupancy Sprinklered DYes DNo 0 Req'd. PHONE Valuation Budding Area In Sq. Ft. ADDRESS ZIP DWL Area I Basement Area r Garage Area Storage CHANGE OF USE FROM 6. TYPE 7. OF WORK TO ❑ NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE. ❑ BLD. 0 PLMB. 0 MECH. 0 M.H. *0 POOL 0 OTHER Split Level l Rancher No. Baths 1 No. No. Roo1ns/ Rec. Room CERTIFICATE of EXEMPTION Req'd. Reed. Not Req'd. DESCRI E WORK �n 40/1-4 8. VALUATION a cv.-ooDao ALUATIONaD Sour e mrd oD-- Utilities GAS 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 correc . 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 regglating construction or the performance of construction. ,/ 1 Ale - SIGNATURE DATE JO -9" 7 9 DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CONDITIONS: DATE/0-9-79 OFFICIAL kAirli APPROVED FOR ISSUANCE FEES COLLECTED' Single $ Building Plumbing , Mech. Plan Check SEPA• Mobile Home Other (Specify) TOTAL o..- PERMIT NUMBER 7q- SSSS DATE/0 -y�7I 04* *3250 *3250 ta *32506 E *,000 8 55542 10=09.79 2 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 110''t.0'91-17'9• 545'5.5 z *3 2 51.0 2 CC O 0 w n.