1980, 01-21 Permit: 80-394 Furnace!PLAN 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
1.
JOB ADDRESS
LOT
2.
OWNE
3.
4. AD Dlt ESS
BLOCK
L. 7 CJ$'�
SUBDIVISION
ADDRESS
Q ACTOR
C�
DESIGNER
5. ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
C4
PHONE
PARCEL NUMBER /S
ZI P
Required Set Backs in Feet
North 'South
East
Z
Size of Parcel
PHONE
Type Const.
Valuation
ZIP
Occupancy
DWL Area I Basement Area
(West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area I Storage
6.
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
KNEW ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
DESCRIBE WORK
8. �.'
VALUATION
9.
Source
of
Utilities
GAS
ELECT IC
WATER
SEWER
I hereby certify that I have read and
on reverse side, and know the same
type of work will be complied with
to give authority to violate or cancel
performance of construction.
DATE S . 9 7 7 )
examined this application and have read the "NOTICE" provisions included
to be true and correct. All provisions of laws and ordinances governing this
whether specified herein or not. The granting of a permit does not presume
the provisions of any other state or local law regulating construction or the
SIGNATURE w%
• SPECIAL APPROVALS
DEPT. REQ'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
REC'D.
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE -R1 5ZOFFICIAL
APPROVED FOR ISSUANCE
Recd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $R
DATE
PERMIT NUMBER
14\ t4O— 3R Lk
04* *7,00
*7,00
*7.00U
E *0.00 S
39.32
01 -21 -80
61479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES / PERMIT.
0'1-21 -.80'
39, 4z
*7.0 0 F-
DATE
RECORD OF INSPECTIONS
REMARKS
Final Inspection
INSPECTED BY