1981, 06-01 Permit: 81A-5301 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
2.
JOB ADDRESS
LOT BLOCK SUBDIVISION
7
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
3.
4' ADDRESS
OWNER
AD
DRESS
CO NTR
_sue eg ✓ % e.
PHONE
ZIP
PHONE
Actual Set Backs in Feet
North
Size of Parcel
South
East
West
Zone Classification
5' ADDRESS
ZIP
91-Z/,/
PHONE
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks 1 Finished Basement
TYPE
7, OF
WORK
,Tier NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
Unfin. Basement
No. Rooms INo. of Dwellings
DESCRIBE WOR
VALUATION SOURCE GAS
OF
Q, UTILITIES
teC
ELECTRIC WATER
CERTI FICATE
of EXEMPTION
Enum. Dist, I Location (Area)
Req'd. Rec'd. Not Req'd.
SEWER
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION •=f7
SIGNATURE OF APPLICANT oL /d( j
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT Ui+1BEk
Olt* * 1 4,00
* 1 4,00
* 1 4,006
A *000
530,02
06-01-8,1
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
530.1z *laooat -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL