1979, 09-17 Permit: M79-4150 FireplacePLAN 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
S lZos O6>rRLJN ARO
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
2.
OWNER
3. GLIrroP-0 1-k) 4&—r. vi
ADDRESS
S _ 12t 5' L'&ER.L4 iJ
CONTRACTOR
4 Sp
ADDRESS
PHONE
Cj2 -`11946
ZI P
i92.o6
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South [East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
rJ. ADDRESS
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
DWL Area f Basement Area Garage Area I Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. IN 'TA..LAr71oN OF ' 0" CLERA/qCC. j=1112 . PLAc.. _
VALUATION Source ELECTRIC
9. S�1 of
ao Utilities
GAS
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. d
DATE Z-'�7--r SIGNATUR�
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
4 Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
DATE OFFICIAL
nnnn..rn rnn .nn..n n.nr
07. 41-e7
TOTAL $.
M
PERMIT NUMBER
7?- ¥15a
DATE s 'T. 1711171
04* *7.00
*7.00
414.9-2
09-17-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
9-17-79
41 5.0 0
*7.0 0
OJ
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