1979, 11-15 Permit: 79-7933 Heater, Piping PLAN NUMBER PERMIT NUMBER
APPLICATION/PERMIT _ 77-33SPOKANE COUNTY BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES ��11 �11
JOB ADDRESS ` V * * 1 �'V C
1 I2 rd6 �l✓� /" /" LEGAL DESCRIPTION - SEE ATTACHED * 1 2 0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S 7 9 3. 2
2.
OWNER G PrPHOO/yNE 1 1 — 1 5—7 9
3' ADDR �SS ��j(�� �' L I ��� LIP Required Set Backs in Feet g 6.4 7 9,
• 1� �4 'p1 /6,,,,,. ..,
99')-1 North ISouth East IWest
CO NTRACTOF6 PHONE Size of Parcel Zone Classification
4. ADDRESS 0ZIP Type Const. Occupancy Sprinklered
El Yes ❑No Cl 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 ,�/ ❑ OTHER CERTIFICATE - Req'd. Recd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. LVA MECH: 1:1 M.H. CI POOL
of EXEMPTION
DESCRIBE WORK
8. rI r I N14 f U NI I /
FEES COLLECTED
VAL ATION Sour_e
GAS ELECTRIC WATER SEWER
of X X
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 local law regulating construction or the
performance of construction. Plumbing
00
DATE k.o V /5 . , 9 79 SIGNATURE_ L. Mech /"--
SPECIAL
z
SPECIAL APPROVALS SPECIAL CONDITIONS: �_,�,1 r
DEPT. REQ'D. REC'D. Arm pAV'J-T ,I1r(� Plan Check
Env. Health r Y 1
c
SEPA P
Planning — w
1
a Mobile Home °
Fire Marshall -_
Co. Engineer F Other(Specify)
UtilitiesTOTAL $ I. r UQ
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist 1
THIS BECOMES A PERMIT. 1 fir,
DATE //'5 •" ICIAL� �_ i
At"ICED FOR ISSUANCE _
PEEWIT N3.
=Mtn NO.
y�
kiC_A,/ ARD C, D e- z .e L , lermy certify that I mm
making my own gas egadpasnt installation within my own building and,
Further eertify that I know Frog to mks this entire installation in eompliaanee
with the Gas Code me well as all required tests for tightness, proper input,
etc., or will have 4 S TPA/ W A r.1¢,2 the required
tests for ma upon completion of this installation and bsfore final inspection.
Name
Eiasn6 zw7� A•
vg
Address
Signed and vitaoeaod this /5-
day of.., . ti 4 s 197J
Notary ?labile for the Stats of Washington
lasidin3 in Spokane