1981, 10-13 Permit: 81B-0612 Install Conversion BurnerPLAN NUMBER
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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.
2.
3.
JOB ADDRESS 3.C)\ 'kg
LOT
BLOCK SUBDIVISION
OWNER /!
etc•! u
ADDRESS
O NTRACTCit t*iritiki(C 4' ADDRESS r.
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DESIGNER
tiUIG
PHQN
5.
az7
,ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South East (West
Size of Parcel
Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Valuation
Main Floor I Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
L"f ALT. , ,
❑��A�D'N. ❑ RPL.
❑ PLMB. 'fJ MECH. ❑ M.H.
DESCRIBE WO:R4k-
8.
VALUATION
9.
SOURCE
OF
UTILITIES
I L l (V'7\it kiS (L.
ELECTRIC
GAS
d and
❑ MVE.
I=1 OTHER
❑ POOL
i'v
W TER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
`l 0
CERTIFICATE
of EXEMPTION
Enum. Dist, I Location (Area)
SEWER
Ownership
Public ❑ Private r]
USE CODE
Req'd.
I hereby certify that I have re 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. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
/ 0
DATE OF APPLICATION ,.-. i i (6( SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
BLildi echnician
SPECIAL CONDITIONS:
FOR GAS APPLIANCES
PIPE SIZES (I` 4-- ll2_
PIPE LENGTHS f
BTUS /00)000
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. `8
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 12)•C'°
PERMIT NUMBER
04* *1 &00
* 18,00 rri
* 18.006
A *000 Ca
61.12
10 -13 -81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
-.1•3-8 1
6L2z *18.00°1 -
DATE ISSUED PERMIT NO.