1979, 10-03 Permit: 79-5184 Furnace PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
iv? 7 ; 1g,�
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE �t` A- 7q
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
04 * *7.00
JOB ADDRESS - LEGAL DESCRIPTION - SEE ATTACHED
1. � ) f_c-, -.,.,set, • * 7 0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S u)
2.
* 7,Q0
r
OWNER PHONE E * O
3. (� l \,,,,,,,-(- 1\
,,,,_.•
ADDRESS ZIP Required Set Backs in Feet 5 1 8 3 2
-) j I --,k_K_ t �cq.,1 t�� North South East West
CONTRACTOR PHONE Size of Parcel Zone Classification 1 0—0 3—7 9
r'
C13--
-'x-\ iv'Qi t_�2\-.C�,C 7 :)-S- --),"5 '•)- 2 6 Q 7 9.
4. ADDRESS 1 �1 ZIPType Const. Occupancy Sprinklered
L- , rf . C'CI uL.A, ' IIPc) ,C(C., Eves ❑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.
No. Baths No. Floors No. Rooms Rec. Room
TYPE C NEW D ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. . MECH: ❑ M.H. ❑ POOL
of EXEMPTION
DESCRIBE WORK COLLECTED
(�
VALUATION Source GAS ELECTRIC WATER SEWER
of .X �,
9. utilities \ Single $
9 _
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
Plumbing
performance of construction. ,
DATE SIGNATURE )�IYl kk... 'AA Mech. -7. L C)
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA o._l
Planning — C
1 0.
Mobile Home
Fire Marshall
•
14
Co. Engineer Other (Specify)
Utilities TOTAL $ ) • <'
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES ApERMIT.
SEPA Checklist p y/�/L�_L�_t4- r '1 -- i rl -- * i';;i� �'
DATE){y� OFFIC _� _
APP FOR ISSUANCE