1980, 03-24 Permit: 80-2625 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
1.
2.
3.
4.
5.
JOB ADDRESS
ILL,/
L T I
BLOCK
SUBDIVISION(
OWNER
rJ��P ,14(g LA')
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
PHONE
ADDRESS 1
13 J( > _
C NTRACTOR
ZIP
qQ2 '
Actual Set Backs in Feet
North 'South East (West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
DESIGNER
ZI P
9 9,C®.l
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW ❑ ALT.❑ AD'N. D RPL. ❑ MVE.
❑ BLD. ❑ PLMB. A MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK 0d
8. 1/.00/00d L3Tl) A5 GllAzeJAc
VALUATION GAS ELECTRIC WATER
9.
SOURCE
OF
UTILITIES
Enum. Dist.
ILocation (Area)
SEWER
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 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
DATE OF APPLICATION .A -24 -ed SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildiing Technician
SPECIAL CONDITIONS:
//
/
PIPE
/ 11 ' // /7/ PE
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
i
TOTAL $
PERMIT NUMBER
Fd -
04* *12,00
* 12,00
* 12.008
E *0.00
262.42
03-24-80
2 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0151'2'4.=r0 262.5 *12.002 -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL