1979, 08-27 Permit 79-2867 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
3.
JOB AD.RESS
LOT
OWNER
BLO K
ADDRESS
CONTRAS •,
4. A.DR�..--
DESIGNER
SUBDIVISION
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PJzI,O N E
ZIP
ONE
51-75-0
zao9
PHONE
ZIP
TO
Tr.AADD'N. ❑ RPL.
Lld'MECH: ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
DESCRIBE WORK
8.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North
South
Size of Parcel
Type Const.
Occupancy
Valuation
DWL Area
Basement Area
Split Entry
No. Baths
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
A
WATER
Storage
Rancher
No. Rooms
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 regula ing construction or the
performance of constru tion.
DATE S /7
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SPECIAL CONDITIONS:
Rec. Room
Rec'd. Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 69
M
PERMIT NUMBER
DATE G — 1 i 127
04* *7.00
*7.00 to-
*7.006
A *Q00
2866g
08-27-79
g 6479,
SEPA Checklist
DATE
OFFICI
WHEN MACHINE VALIDATED IN THIS SPACE,
THISU 8COMF A PERMIT.
286,75 *7,002.