1981, 01-27 Permit: 81A-0937 Conversion BurnerPLAN 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 ADD ESS
/c Q70.3
ail
LOT BL CK (VISION
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
OW
ADD E5S eJ2
CONTRACTOR
ems'
ADIDRUS
0 QA
t DESIGNER
P ONE 7
ZIP
PHONE 7S
PARCEL NUMBER /S
Required Set Backs in Feet
North 'South
East 'West
Size of Parcel
Zone Classification
ZIP
PHONE
Type Const.
Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
Valuation 1Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
ILKEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. CH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBEp�WORK
8. A ION
9.
Source GAS
of
Utilities
ELECTRIC
WATER
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 regulating construction or the
performance of construction.
DATE /- y5''iJ IJ'�C
Z SI GNATURE
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FOR GAS:
PIPE SIZES:
f 02
PIPE LENGTHS: S
BTU'S:
r r °
/e-e Mr1-- / Q
i o
DATE / � OFFICI
APPROVED
ISSUANCE
U ,o
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
/ 0 C2
ub
$ 73
DATE
PERMIT NUMBER
G� -37
04* *180.0
* 1800
* 18.006
A *0,00
936
01- 27 -8.1
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACF
TH ISd31COIXIWA.gyMIT. ,z
*1'8,00IR'
s
DATE REMARKS
61S:1 4tIgM3-
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY