1981, 01-15 Permit: 81A-0509 FurnacePLAN NUMBER
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APPLICATION/PERMIT
SPOKANE COUNTY — BU:LDIrviC, CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
• f_' .W.‘571/45-
LOT
;J /.DLOT BLOCK
SUBDIVISION
3�V
. i-✓n�-��1EfQ
ADDRESS
&&01-0-7/Ce.,
j�
01- -y%2a s��CI /ti7iCf m
(C�.ONTRAAdCTOR
g g 7 A,-1� ,ia ,4_, � ' l .tet
DESIGNER
rJ. ADDRESS
PHONE
ZIP
98204,
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
CHANGE OF US FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PHONE
ZIP
❑ AD'N.
MECH.
❑ RPL.
D M.H.
❑ MVE.
❑ POOL
❑ OTHER
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
Actual Set Backs in Feet
North
South East
Size of Parcel
Type Const.
West
Zone Classification
Sprinklered
❑Yes No ❑ Req'd.
Valuation
Main Floor
Area of Decks
No. Baths
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories No. Rooms
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. of Dwellings
Location (Area)
SEWER
Ownership
Public ❑ Private ❑
Req'd. Rec'd.
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
LAPP
DATE OF`APPLICATION SIGNATURE OF APPLICANT L (G�c'"4. ;;;7.5"/l�
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu (ding Tecpinicirt
-viz
niKkikb
r,T
PERMIT IS NONTRANSFERABLE
i
2,, 00
i� op
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
'A A -
04* *19,00
* 1 9,00
* 1 9.006
A *0,00
50.82
01-15-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
o .411
5o. 9g *19.0020
DATE ISSUED
PERMIT NO. TOTAL