1980, 09-02 Permit: 80-9403 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 3 COPIES
2.
JOB ADDRESS
LOT BLOCK /z (r /J
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER,,,X
PHONE
'7X/229
PARCEL NUMBER/S
ADDRESS
ZIP
Actual Set Backs in Feet
North 'South
East
(West
4.
5.
CONTRACTOR
/7 G,,t- Y':••
raw 1/
el I
PHONE
Size of Parcel I Zone Classification
ADDRESS /
/ ' r i -f L✓
DESIGNER
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
D PLMB.
❑ AD'N.
i MECH.
RPL. ❑ MVE.
❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIB. WORK
H. A c
VALU TI N
9.
Enum. Dist.
}
'Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 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 construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
C
DATE OF APPLICATION p '
SIGNATURE OF APPLICANT
SPECIAL .APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
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 NUMBER
- O3
04* *9.00
*9.00 to -
*9.006
A *000
940.2
09-02-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09`-021.8'x`
DATE ISSUED
940,35
PERMIT NO.
—
*9.00°
TOTAL