1979, 10-05 Permit 79-5393 Gas UpflowPLAN 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
3.
4.
6.
JOB ADDRESS ei
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LOT BLOCK SUBDIVISION
OWNER
ADDRESS
CONTROR
ADD ES
DESIGNER
ADDRESS
463 )a
' it/Joiotit
CHANGE OF USE FROM
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
D CR) E WORK ��,jj''��
8 V AT ON ra t ource� G/�5(��VR1°
of6j L
Q, Utilities/[_
PHONE
Zgq /
PHONE
❑ ALT. ❑ AD'N. ❑ RPL. D MVE.
❑ PLMB. klECH: ❑ M.H. 0 POOL
0 OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North South East West
Size of Parcel
Type Const.
Valuation
DWL Area
Split Entry
No. Baths
Zone Classification
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Basement Area
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
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
performan>cc of,construction.if
DATE r 7� SIGNATURE
I
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
I I ▪ (Dodud-6007-k_
DATE10 -79L-,0(10.4t122-'
- / /OFFICIAI
APPROVED FOR ISSUANCE
No. Rooms
Req'd.
Storage
Rancher
Rec. Room
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
;
Mech. //L
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ / /°u
PERMIT NUMBER
79 -.3.33
DATE /O -'5 - 79
0 * *1200
* 1200
* 12006
E *Q00
539,22
10-05-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-05-7.9 5.3935 *120,02F-1