1981, 02-09 Permit: 81A-1275 Oil to GasPLAN 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
JOB ADDRESS
LO BLOC SU !VISION
3 4,4 ,.a V>r „;„'1:1,
ADDREjJ�
CONTRACT R
• A DRESS
5.
PHONE
7517-77-
ZIP
99.x/6
9 , .Zak
ZIP
. , 1.,N -h esr-% 91/6
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
El ALT.
❑ PLMB.
❑ AD'N.
MECH.
❑ RPL.
❑ M.H.
PHONE
ZIP
❑ MVE.
❑ POOL
❑ OTHER
DESCRIBE WORK
VALUATION SOURCW
OF
9. UTILITIES
GAS
ELECTRIC ATER
J/� lair
SEWER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North
South East
Size of Parcel
Type Const.
Occupancy
Valuation
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor Upper Floors Garage Area
Area of Decks
No. Baths
Storage
Finished Basemen
Unfin. Basement
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Req'd.
Ownership
Public ❑ Private ❑
Location (Area)
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 regul.ting construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSP IONS
DATE OF APPLICATION —-I SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
,e/
PERMIT NUMBER
i;4* *1 &00
* 1800 to-
* 18.00
A *000 c`°,
127,48
02 -09 -81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02; -04
DATE ISSUED PERMIT NO. TOTAL
-81
127.52 *18r00(20