1979, 10-10 Permit: 79-5693 Gas Conversion PLAN NUMBER APPLICATION/PERMIT �f PERMIT NUMBER I
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
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NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
DATE„1,1/G) 79
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
04* * 1 2'00
SOB ADDRESS .,,kEC&' L DESCRIPTION — SEE ATTACHED * 1 2.0 0 i
1. joZ C 190_, -i — B - * 1 .2000
LOT BL CK SUBDIVISION PARCEL NUMBER/S Y
2. Q
O ,NER PHONE E * 0 0 V
a ADDRESS
�/�1 J /// ZIP r� ^ Required Set Backs in Feet
I�
`�o.R ✓[/. il-ff—--(/f91. g�.2,Ni f North (South East 'West 1 0— 1 0—7 9
CONT AC'O-R /sr PHONE Size of Parcel Zone Classification
4. 7i 4' J, ..xi-k .t-�% ��i,L"C.A5,39 R 6 4 7 9.
AD RE'S/S/,,r� �) �1 ZIP Type Const. Occupancy Sprinklered
i a.. 1 ^7G/!Ji.Y_� �'rL-f qy / ❑Yes ❑No ❑ Req'd-
DESIG ESR PHONE v Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I 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. El AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. LIMECH: ElM.H. I=1POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK .
—
p `1 FEES COLLECTED
8. L�!►-ki.4.1.� t2.r� % L�.u� .LD' .,tom. L�1 a7) ,�3 )
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 loc. Ia reg - 'I, co-struction or the
performance of construction. ' Plumbing
P
DATE AO —/LJ"''7" SIGNATURE x /A►, / ,�� Mech. f°' ---
r Iii, dr
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. yn � Plan Check
7 /
Env. Health a/ / `�P
j ii sl SEPA
Planning `�I'}J�' -- CD
— V
w
0-
Fire Marshall Mobile Home N
Z
Co. Engineer Other (Specify)
Utilities
TOTAL $ /..
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist �1 THIS BECOMES A PERMIT.
,;j-K, /O^//-7 DATA-id-7?OFFICIAL 4• �1..1, . g,.�_ 1 Oj-a 7'9 5'6 9.3 z * 120.,0 a
APPROVED FOR ISSUANCE —