1979, 11-09 Permit: G79-7534 FurnacePLAN 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
1.
2.
3.
4.
JOB ADDRESS
LOT
BLOCK
UADIVI/ION / 61h aLtt/
LEGAL DESCRIPTION — SEE ATTACHED
5.
OWN
ciwN EB- �j�,-���/�� arms
E 14f 6olt (494-00
Tg -A:6
RESSOM'
( n j
DESIGNER �,/J1� /j(�\��{�J
9 -
ZIP
PARCEL
NUMBER/S
Required Set Backs in Feet
North 'South East (West
PHONE
z4 9ao
PHONE
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
•
TYPE NEW ❑ ALT. 0 AD N. ❑ RPL. 0 MVE.
7. OF 11
WORK ❑ BLD. ❑ PLMB. ECH: ❑ M.H. 0 POOL
DESCRIBE WORK
8.\r Ac 10)gyc)p C +S 1 50C
VALUA I N Sourc GAS EL RIC
of
9. Utilities
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
I,1 11 „ k FEES COLLECTED
WATER
SEWER
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.j
DATE I t/6/ I tr1 SIGNATURE'
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
Cali,- Jam"
SPECIAL CONDITIONS:
- I5'
1" - ac
71- 3
Single $
Building
Plumbing
Mech.
4
DATE OFFICIAL
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
— s3y
DATE
04*
* 1 7.00
*17.00
7533'
11-09,-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11-097=7'9 753.42
*,17.00°�
L