1979, 09-20 Permit: 79-4359 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
1.
2.
JOB ADDRESS ()ail
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LOT BLOCK SUBDIVI N
LEGAL DESCRIPTION — SEE ATTACHED
3
ADDRE,9e; g
CON, ACTOR
S
2 07DESIGNER
5.
PHONE
PARCEL NUMBER/S
Z9c6
Required Set Backs in Feet
North !South East (West
P4;;-//76)
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Yes ❑No ❑ Req'd.
PHONE
Valuation 1Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
D NEW ❑ ALT.�❑/AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. LiS1 MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd,
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
ELECTRIC
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.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE/O/7/ OFFICI
APPROV
FOR I DANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
4
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $qa)
PERMIT NUMBER
-4-55/
DATE
L; p. *
E
435,8A
09-20-79
g 6,479.
*9.00
* 9.00
* 9.008
* 0.00
1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-20-7
35,9 *9.00
O -J
aI-