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.