1981, 04-14 Permit: 81A-3544 FurnacePHONE
ZIE
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PHONE
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.
Valuation (Building Area in Sq. Ft.
ZIP
TO
❑ ALT.
❑ PLMB.
PLAN NUMBEF.
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
fe- r/ ? ej. &./ iJ, dl./
LOT
BLOCK
SUBDIVISION
OWNER
i aJvt"
AD
DRESS
CONT ACTO
� Y 10 fi" /2..4z L'-j ;-,/.
4' AD7ESS
DESIGNER
5. ADDRESS
PHONE
ZIP
CHANGE OF USE F ROM
6.
TYPE
7, OF
WORK
..1?f NEW
❑ BLD.
❑ AD N. ❑ RPL. ❑ MVE.
.r•J MECH. ❑ M.H. ❑ POOL
DESCRIBE WOR
8. e�I / i"'� &../
VALUATION
9.
SOUP RCE
O F
UTILITIES
-/GAS
if
t.. ear
ELECTRIC
Main Floor
Upper Floors 1 Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
Enum. Dist. I Location (Area)
WATER
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 cons €ruction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION 4,c� >` r
7 '/ `,r SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
uilding
ian
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUM °ER
Obi* *1&00
* 14.00
* 1 4,006
A *000
354,32
04 -14 -81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'41 14'f =' 'I 3'5 4,4 2 *1 4, 0 0 a –
DATE ISSUED PERMIT NO. TOTAL