1981, 09-24 Permit: 81A-9760 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / 1509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1.
LOT
2.
/7 /
LEGAL DESCRIPTION — SEE ATTACHED
BLOCK
SUB DIVIS IO
3.
OWN;M*
DRESS U o
/
CON ACTOR
4. SS
, (2// J eY2/
DESIGNER
5' ADDRESS
ZJE
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North !South [East 'West
PHONE
Size of Parcel I Zone Classification
Type Const.
Occupancy
Spr1nklered
Oyes ❑No 0 Req'd.
PHONE
Valuation [Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
O NEW
❑ BLD.
❑ ALT.❑�,/AD'N. ❑ RPL. ❑ MVE.
O PLMB. LCJ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths No. Floors I No. Rooms
CERTIFICATE Req'd.
of EXEMPTION
Rec. Room
Rec'd.
Not Req'd.
DE,SCRIBE WORK
VALUATION I Source GAS ELECTRIC
I of
9.
Utilities
WATER
SEWER
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.
DATE 9 G `�/�/ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FOR GAS:
PIPE SIZES: � 1/
PIPE LENGTHS:
BTU ' S : /49/ OGYi
DATE OFFICIAL
'//
/ i/
APPROVED FOR ISSUA CE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne - - -
Other (Specify)
TOTAL $<etr/
PERMIT NUMBER
�if(r `cri`crlJ
DATE
WHEN MACHINE VALIDATED IN THIS SPACE,
7H1� BECOMES A PERMIT.
09-124-81 976,05 *-18,002I-
J
RECORD OF INSPECTIONS
Final Inspection
DALE REMARKS INSPECTED BY