1979, 09-25 Permit: 79-4643 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
JOB ADDRESS '
�� LEGAL DESCRIPTION - SEE ATTACHED
LOT I BLOCK SUBDIVISION PARCEL NUMBER/S
,8 1PERMIT NUMBER
�9 -4&
DATE '
04 * * 1 4.00
*14.00
* 1 4,00
E *0.00
4642
09-25-79
-* 0479.
VALUATION Source GAS ELEC RIC WATER SEWER
OWNER
of
9. Utilities
PHONE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
3.
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 SIGNATURE
ADDRESS
—
Mech��
SPECIAL APPROVALS SPECIAL CONDITIONS.
ZIP
Required Set Backs in Feet
Plan Check
Env. Health �jG%
i v
SEPA
Planning
_
North South
East West
Fire Marshall
CONTRACTOR
Co. Engineer
Other (Specify)
Utilities
PHONE
Size of Parcel
Zone Classification
Zone Clearance
GLS
SEPA Checklist
'
(�1 /� (� (1
2 5 — 7 9 " t 1 J c23 * `. U U r
4'
ADDR SS
ZIP
Type Const.
Occupancy
Sprinklered
❑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.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE ❑ NEW ❑ALT.
11 AD'N.
El RPL.
F-1 MVE.
],
OF
moi/ ®q
❑OTHER
❑ BLD. ElPLMB.
L'1V'/y/ibl�C'H:
❑ M.H.
❑POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
8
DESCRIBE WORK
/®�
FEES COLLECTED
,aad
,8 1PERMIT NUMBER
�9 -4&
DATE '
04 * * 1 4.00
*14.00
* 1 4,00
E *0.00
4642
09-25-79
-* 0479.
VALUATION Source GAS ELEC RIC WATER SEWER
of
9. Utilities
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 SIGNATURE
—
Mech��
SPECIAL APPROVALS SPECIAL CONDITIONS.
DEPT. REQ'D. RECD.
Plan Check
Env. Health �jG%
i v
SEPA
Planning
_
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THISBECOMES A PERMIT.
(�1 /� (� (1
2 5 — 7 9 " t 1 J c23 * `. U U r
DATE OFFICIAL
`' ;L