1979, 09-07 Permit: 79-3549 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
JO AD KESS
1. li. j Y,2 3 �`c r ce
LOT BL CK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
2.
0
IdO l/
Ler
DDRE
3
CON RACTOR
717- 5-0
ZIP
9ao(
PHONE
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South 1East 'West
Size of Parcel 1 Zone Classification
' ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER
J. ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
ikr ALT.
0 PLMB.
O AD'N.
O MECH:
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
D SCRIBE WORK A
8. e7l9,f L,;/ 7`CL oQfUCe
VALUAT$ON Source
of
9. Utilities
Gas
GAS n
ELECTRIC
WATER
SEWER
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 of construction.
DATE q 2- `
SIGNATURE
r
41.
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
SPECIAL CONDITIONS: n
Gas , 7 = o5 660
fvokiv
va
115 °!i'/ ff/feWg
fro
Zone Clearance
SEPA Checklist
DATE 9-7-7/ OFFICIAL.,E4Of�
FEES COLLECTED
Single $
Building
Plumbing
•
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
79- 3-5-
DATE 9- 7 -747
04* *14.00
*1400
354,88
09-07-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n9 -n7-79
5549`3 *1404°IF-