1981, 12-11 Permit: 81B-2656 Install 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 3 COPIES
1.
JOB ADDRESS _
2.
3.
LOT
OWNER
ADDRESS
BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
T —(7S3
Zri qZ- j (1l
4.
CONTRACWIR
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel
Zone Classification
ADDRESS
5.
%lam �Ji91
DESIGNER
Zlp' 9
7
Type Const. Occupancy
Sprinklered
DYes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor I Upper Floors ( Garage Area
Storage
CHANGE OF LISE FROM
6. j��
TO
C
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
L4 "ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
Li�ICAECH. ❑ M.H. ❑ POOL
❑ PLMB.
8.
DESCRIBE Yi/13-14K
� � 1
VALUATION
1% .7 N
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
No. Baths
No. Stories
J
CERTIFICATE
of EXEMPTION
No. Rooms
No. of Dwellings
Req'd.
Rec'd.
Not Req'd.
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
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/?egulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIOI\
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
g T nician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
FOR GAS APPLIANCES
PIPE SIZES .‘
PIPE LENGTHS L„
BTUS
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing Mech. 41_0
Plan Check
SEPA
Mobile Home
Other (Specify)
$
TOTA L
PERMIT NUMBER
04* *1800
* 1800
* 18006
A *000
265,5 -
12 -11 81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
127Ti 81 26:56 z *18.0Oa1-2 _
DATE ISSUED PERMIT NO. TOTAL
'