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1979, 11-15 Permit G79-7846 FurnacePLAN NUMBER APPLICATION/PERMIT SPOKANE COUNTY — BUILDING CODES DEPARTMENT NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 JOB ADDRESS LOT BLOCK APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES SUBDIVISION OWNER ` 3 L /A/C:L'G ✓t/ /4 'r—Z./,9/lif ADDRESS /01 7/ ONTRACTOR ON.E 4 933 z0.92e94, PHONE 4' f ADDRESS ZIP /V /ZZ hi G /9- 5' ADDRESS DESIGNER CHANGE OF USE FROM 6. TYPE 7. OF WORK ❑ NEW ❑ BLD. DESCRIBE WORK ❑ ALT. ❑ PLMB. VALUATION 9. ❑ AD'N. .A:(RPL. 'MECH: ❑ M.H. PHONE ❑ MVE. ❑ POOL ❑ OTHER LEGAL DESCRIPTION — SEE ATTACHED PARCEL NUMBER/S Required Set Backs in Feet North (South Size of Parcel Type Const. Valuation Split Entry No. Baths Occupancy East (West Zone Classification Sprinklered ❑Yes ❑No ❑ Req'd. Building Area in Sq. Ft. Split Level No. Floors CERTIFICATE of EXEMPTION / 2/,e,✓/1(1: .GO.✓/✓r,V ©//,i7z-/e'er GAS SEWER X Source of Utilities ELECTRIC WATER 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 regulating construction or the performance of construction. DATE //--i, "7 SIGNATUR DEPT, Env. Health SPECIAL APPROVALS REC'D. REC'D. Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CONDITIONS: No. Rooms Storage Rancher Req'd. Rec'd DATE <�//15- l OFFICIAL ' G /L.l_.(_) Rec. Room Not Req'd. FEES COLLECTED Single $ Building Plumbing Mech. /,, Plan Check SEPA Mobile Home Other (Specify) TOTAL $ j PERMIT NUMBER . #1- 1 --14646 DATE /7'42 — %J C 4 * *1 1.00 E 784,3 11-15-79 2 6479, 784.4� 11-15-79 2 6479. * 1 1.0 0 N * 1 1.006 *000 0 WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 1.1-15—,79 784:6Z *1.1,00.°� APPROVED FOR ISSUANCE