1979, 10-04 Permit: 79-5305 Furnace �PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER I
* SPOKANE COUNTY — BUILDING CODES DEPARTMENT H 7� �3oS
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE /0— = (f
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES 0 4 * * 7.0 0
JO ADDRESS
1. l22 Z U�L(�y on/ LEGAL DESCRIPTION - SEE ATTACHED * 7,0 G U)
f 19
LOT BLOCK SUBDIVISION PARCEL NUMBER/S 135-4'3 2 — �yp.r1 *7,0 0
2. 25" IJ 11 O n� EY T J ` r� B n 0
OWNER PHONE Z �� 8y� * �'
3. j/4v1 /J I )co ��"�-A-
ADDRESS a/ / Q'���//// ZIP Required Set Backs in Feet 5 3 0. 4 n
y 1 2ZZ Vt'Ivz-[b71.04/ North [South [East (West 1 0-04-79
CONTRACTOR / / PHONE Size of Parcel Zonelassification
a. -Flv 4 24- 35-31 4r 2 6,4 7 9,
ADDR SS ered
f.72/ Type Const. Occupancy Sprin❑Yes to kl❑ 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.
TYPENo. Baths No. Floors No. Rooms Rec. Room
❑ NEW ALT. ❑ AD'N. D RPL. ❑ MVE.
7, OF � ❑ OTHER -
WORK "i4 ��[\
�` ❑ BLD. ❑ PLMB. MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Npt,Req'd.
of EXEMPTION
DESCRIBE WORK FEES COLLECTED
8. /VE_J nice-AJ
VALUATION Source GAS ELECTRIC WATER SEWER
of (/�\j
a 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
/C,--1 r / SIGNATURE a'� A.AvviL4---._ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
cC
SEPA `D
Planning — w
cip
Mobile Home
Fire Marshall
Co. Engineer Other(Specify)
Utilities .--e -
TOTAL $�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ��77 {nl,,, THIS B COMES A PE MIT. S 7 (}
DATE IO_LI_IOFFICIALc�*'WIY14� Q 1U �- Q4'-7:� 530. 5z * /, 00.,T. II
APPROVED FOR ISSUANCE -