1979, 10-10 Permit: 79-5674 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
JOB ADDRESS ,
LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK SUBDIVISION PARCEL NUMBER/S
2.
OWNER 2)�
3.
ADDRESS
CONTRACTOR
C- k a
4. ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM ITO
6.
PHONE
ZIP
PHONE
Z Pq
PHONE
ZIP
31
TYPE La NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 OF WORK ❑ BLD. ❑ PLMB. �MECH: ElM.H. El
lPOOL OTHER
Required Set Backs in Feet
North South
East West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
DWL Area
Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
Req'd.
I Recd.
Not Req'd.
of EXEMPTION
DESCRIBE WORK FEES COLLECTED
8. 1� � -, Sc– ^ �:' �� c cs° s _.
VALUATION Source GAS 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 regulating construction or the
performance of construction.
Plumbing
DATE 0 SIGNATURE �lS G,Q �iw" Mech. L �'
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SPECIAL CONDITIONS:
SEPA Checklist t
DATE (0 iU �IOFFICI ^
APPR FOR ISSUANCE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �1C1
PERMIT NUMBER��
M --T-)6
DATE )6; �jl 7 �i
04* *7.00
*7.00
*7006
E *000
567.32
10-10-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COI�II A MIT.
1 —1 '-l�' 56Z4z
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