1980, 09-23 Permit: 80B-719 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
JOB ADDRESS
6 32
LOT
BLOCK
SUBDIVISION
OWNER
3. f 1.s9ee riil/ /37, cc �•c
ADDRESS
6: /3e/5 .t3cce
PHONE
e(7/ -.39z-7
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
CONTRACTOR
4 45i5/7?e
' ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
NEW
❑ BLD.
PHONE
ZIP
PHONE
ZIP
TO
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. R/MECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
a %l1/1/44,ct-/
VALUATION
9.
4
SOURCE
OF
UTI LITI ES
,
vC-
GAS
ELECTRIC
WATER
SEWER
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
East West
Occupancy
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
No. of Dwellings
Req'd. Rec'd.
Location (Area)
Ownership
Public D 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
DATE OF APP►.ICATION 9 —3
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildm
Technician
y . 9//c
SIGNATURE OF APPLICANL%{�C1" 14 0 I
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing Je-7
Mech. /"t
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ `'crb
PERMIT NUMBER
04* *7,00
*7.00
*7006
A *000
71.8
09-23-80
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09, i2,31.'Ll8to'
DATE ISSUED
7192 *7.00 I!' —
PERMIT NO. TOTAL