1980, 09-09 Permit: 80-9861 Furnace, Water HeaterPLAN NUMBER + •
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3
4.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
o �B r' o
`I��Cd[ of
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
5.
OWNER ,,..-1/L4.4-..-'
yML4.4J ^A
ADDRESS - p p_
CONTRACTOR
/1 v
PHONE
ZIP
/n
PHONE
Actual Set Backs In Feet
North 'South East _I West
Size of Parcel I Zone Classification
ADORESS r
DESIGNER
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
O NEW
❑ BLD.
O ALT.
❑ PLMB.
❑ AD'N.
MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DES WORK
8. .d'n�y ..�,rl- 12-C�/G'Ll ,''�,4'I —
V LUATIONI SOURCE GAS ELECTRIC
II OF
9. UTILITIES
1.2
SEWER
WATER
Enum. Dist.
Location (Area)
Ownership
Public ❑ Private 0
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 ermit does not pre ume
to give authority to violate or cancel the provisions of any other state or local law r gul ing constructi. or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION G' _c f — i'G)
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buil Ing Techo clan y
i (2,42 .4—
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
D P
CTAS FUR/v4e fevnan 4370
14,1'47 HEATER ' L3D4c9 art)
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
�1 hJ
'Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL
PERMTr NUMITER
D-- 4' L'/
04*
* 1400
* 1400 N
98602
09-09-80
g 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0930"4_8'01 986.1.5 *14.00a� -
DATE ISSUED PERMIT NO. TOTAL