1979, 10-10 Permit: 79-5664 Furnace F1LAN NUMBER APPLICATION/PERMIT M `1
9 NOGG 4 ,I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
t NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE O 3 i
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS 0 4 * * 7.0 0
1 c O c N ' (\l LEGAL DESCRIPTION — SEE ATTACHED *7.0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S *7.0 0
2.
OWNER PHONE E * 0 0 0 ti
ADDRESS ZIP Required Set Backs in Feet 5 6 6 3 2
A s i r North 'South East West 1 0— 1 0—7 9
CONTRACTOR PHONE Size of Parcel Zone Classification
C\--- 4:--((---- i cwL:',/'\C . .----k:.___ rt�, -5S Z, _�. 2 6 4 7 9.
4' ADDRESS �, ZIP (� Type Const. Occupancy Sprinklered
1 3e, > it %D'C'`t' ❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
TYPE No. Baths No. Floors No. Rooms Rec. Room
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK CIBLD. CIPLMB. MECH: ❑ M.H. 1:1POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
AE
1 j ., k FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
} of
9. Utilities x k X
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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. `� Plumbing
DATE 1 �` CI SIGNATURE jl X52 CIAC Mech. -7' C)
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health
cc
SEPA o v
Planning — w
2
Mobile Home c/)
Fire Marshall z
Co. Engineer Other (Specify)
Utilities
TOTAL $ c,, r)
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist Ni' ' r THIS BECOMES A PERMIT.
�._ ---'"� '_ .' — 1. P. `',t , _ * 7, 0i n
q -
DATE 10 Ib I OFF ' AL ��
APP=:' i OR ISSUANCE