1979, 10-17 Permit: 79-6167 Furnace r2LAN NUMBER APPLICATION/PERMIT PERMIT NUMBER/
(�� SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES 0 4 * * 1 2 0 0
1. Jo DD ESS W`-� �r-1 ( 3 t ) 111 , LEGAL DESCRIPTION — SEE ATTACHED * 1 2 0 0 t5
LOTlcK SUBDIVISION ' PARCEL NUMBER/S * 1 2 0 0 v
2. E * 0.00
OWNt1�y PHONE
1-� �eiY�,c 6 1 6 6 2
3. ) .{+ ZIP Required Set Backs in Feet
ADDRESS/ 3 I t) / _sr-
I North (South East (West 1 0— 1 7-7 9
CONTRA n�R (( PINE, Size of Parcel Zone Classification
Z PAN,�'t�' ,k._14- )4 a- �G 44, - / ( 2 6 4 7 9.
4. ADDRESSi� i ZIP Type Const. Occupancy Sprinklered
_ /i0 77 Bim . / i Eves ❑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. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ��yy ❑ OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK y( BLD. ❑ PLMB. MECH: El M.H. El /
(, ,\ of EXEMPTION
DF�8. ,BBEWORK ( �) 1 L-v � �i� �l t� (� FEES COLLECTED
V DATION Source AS ELECTRIC WATER SEWER
of
9. Utilities X 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 gulatingiconstruction or the Plumbing
performance of construction.
DATE ? ° r' – j 9 SIGNATURE .y"v L. 41Ll?-CI ,',...-1 Mech. 1� .
SPECIAL APPROVALS SPECIA C NDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
r2 / 0r...., iL._C__. SEPA — o
Planning 0.
,t y Mobile Home z
Fire Marshall
V �.Q.-:)
Co. Engineer �� Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist , THIS BECOMES A PERMIT.(y
DATE I�i7/7y OFF - ��r " 10'—'1 7 .-7�7 6' 6, 7 ? *1 2, 0 0 Ct I- ,
AP':, 0 FOR ISSUANCE