1980, 01-08 Permit: 80A-9915 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 4 COPIES
1.
2.
3.
4.
JOB ADDRESS )444 �(
LOT , BL CK UBDIVISIO
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER ADDRESS
CONTRACTOR -
1/`s Imo.
ADDRESS
PHONE
ZI P
Required Set Backs in Feet
North !South 1East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd_
5.
DESK
PHONE
Valuation 1Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
O AD N.
❑ MECH:
❑ RPL.
❑ M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECT RIC
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 ( l Fri) SIGNATUR,...PL
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE J— AFFICIAL aM111171A)
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 1 `
PERMIT NUMBER
DATE
C[i * *7.00
*7.00
*7.000
E *0.00
991.4
01-08-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
TH IS�EGOIjQF,$ /j RE�jMIT. 99 L 5 z * 7.0 0 2F