1980, 12-03 Permit: 80B-4401 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 3 COPIES
1.
2.
3.
JOB ADDRESS ,if
LOT . S/ I o9 N A t k i
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
IxDol • C'U�� J
PHONE
—(Q9u
PARCEL NUMBER /S
ADDRESS
ZIP
Actual Set Backs in Feet
North 'South East (West
CONTRACTO,,Rii••
4. -14to4tr. 1. 1N .
ADDRESS:
PHONE
Size of Parcel
Zone Classification
Z II(P79 ac
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
• NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. .Dit MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8.
9.
DESCRIBE WOR,
VALUATION
SOURCE
OF
UTILITIES
ELEL` IC
roi 00
WATER SEWER
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that 1 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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION 11 c t4-26
b
SIGNATURE OF APPLICANT
Abu
Jt.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Techni
" ao
y tt
gf
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
•O
Plan Check J xl
'lQ '
SEPA
Mobile Home
Other (Specify)
TOTAL
$ia
PERMIT NUMBER
so 1 l t
04* *1200
* 1200
* 12.006
A *0.00
440.02
12 -03 -80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12170.'37810
DATE ISSUED
PERMIT40 1 + 2iwe