1979, 10-30 Permit: M79-7012 StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE /l1
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. C //7.---1() () zC>.
LOT BLOCK SUBDIVI ION
OWNER
3.
ADDRESS
CONTRACTOR
4. 1.• -rtLd
ADDRESS
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBERS
ZIP
•
Required Set Backs in Feet
North 'South East 'West
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Lives ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ PLMB. C,S":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
• V
VALUAPTIOIOr'
9.
s4
So rce GAS ELECTRIC WATER
'of
Utilities
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 gr.nting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or lo.al;law regulating/construction or the
performance of construction. _ �l
DATE /Zi —cSt7 _ / % SIGNATURE r`
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIALIe •12-4-••1,'•'(2-•
_4U,<'(Xi r -rc-
nnnnnvrn rnn 101'1 on Rinr
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
7 2
TOTAL $
04* *700 -
*7.00 t
*7,006
B *Q00
701.1
10-30-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i0`-30'=79 7011.22 ,*7.00
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