1979, 07-31 Permit: 79-1386 StovePLAN 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
JOB ADDRESS
1. L— `-1 1- o (� r`=
LOT BLOCK SUBDIVISION
2. c i!— 'a..4„„-,.,
LEGAL DESCRIPTION — SEE ATTACHED
3.
4.
ADDRESS
f,
2'0 1
CONTRACTOR
c2. t-tia
o
PHONE
Z P
PARCEL NUMBER/S
;2 c) — 3d--0�
Required Set Backs in Feet
North J_South East 'West
PHONE
Size of Parcel
ADDRESS
ZI P
Type Const.
Zone Classificatio
(3I -fe � �E(1
Occupancy Sprinklered
❑Yes ONO ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
ld NEW ❑ ALT.,.❑ AAD'N. ❑ RPL. 1=1 MVE.
LAS
❑ BLD. ❑ PLMB. MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DES RBE WORK
8. L � �r� �z M kI - J
VALUATION
9.
Source
of
Utilities
GAS
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 - C
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL ONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech.
4
DATE OFFICIAL
Plan Check
SEPA
Mobile Home
Other (S ecify)
TOTAL $
•7r 00
DATE
PERMIT NUMBER
79- 3g(
p4* *7.00
*7.00
*7.006
B *0.00
13852
07-31-79
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-31-79 158.67
*7.00°H