1979, 08-14 Permit: 79-2122 Furnace, ACPLAN 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
GAS
JOB ADDRESS
- c
"
SEWER
9.
LEGAL DESCRIPTION -SEE ATTACHED
1.
S I ,•Q
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�F6`
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
LOT
BLOCK
SUBDIVISION
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
PARCEL NUMBER/S
2.
I
SPECIAL APPROVALS SPECIAL CONDITIONS:
T/
DEPT. REQ'D. RECD. * LL Plan Check
OWNER
V' T(/✓V C f%�"✓ /�Q'/^ /1 SEPA
PHONE
t'N 7Li A.
s'rA nr
Mobile Home
Fire Marshall
Co. Engineer Other (SSpecif
Utilities
TOTAL $
3.
Zone Clearance
IN THIS SPACE.
WHEN MACHINE VALIDATED
SEPA Checklist THIS BECOMES A PERMIT.
ATEFFI
2 f-
AL—
A/14D�RE�SSS�]
ZIP
Required Set Backs in Feet
S
y
Y 7V (v/f'��
/C
y2
North South East West
CONTRACTOR
j
PHONE
Size of Parcel
Zone Classification
4'
ADDRESSjj
ZIP
Type Const.
Occupancy
Sprinklered
0
/-&, J f v
-ve 4,14
�? r2 1
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
OWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
I
TYPE ❑NEW
�y
ueQ ALT.
AD'N. RPL.
❑ ❑
❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
❑ OTHER
13BLD.
❑ PLMB.
lk MECH: ElM.H.
13POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
PERMIT NUMBER
>, 2 -
DATE
0 * * .00
*700 U,
*7.0061
A *0,00 00
21 21 2
08-14-79
;? 6479,
DESCRIBE WORK
$• Ire , C � h FEES COLLECTED
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
of
Utilities
e
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
Plumbing
performance of construction.
DATE tiT _ 717 SIGNATURE Mech. 3'd0
SPECIAL APPROVALS SPECIAL CONDITIONS:
T/
DEPT. REQ'D. RECD. * LL Plan Check
Env. Health
V' T(/✓V C f%�"✓ /�Q'/^ /1 SEPA
Planning
t'N 7Li A.
Mobile Home
Fire Marshall
Co. Engineer Other (SSpecif
Utilities
TOTAL $
Zone Clearance
IN THIS SPACE.
WHEN MACHINE VALIDATED
SEPA Checklist THIS BECOMES A PERMIT.
ATEFFI
2 f-
AL—
.-. --