1982, 04-12 Permit: 82A-2700 BoilerPLAN 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
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK SUBDIVISION
PARCEL NUMBER/S
OWNER
3 ,4 11j2:PC '/63f 7�
PHONE
H�yOrN E / , L
i2/—/�52
ADDRESS
2•9ff. /5IA/`7.4z'
CONTRACTOR
ZIP
Actual Set Backs in Feet
North 'South
East Wes
4. i471141-ZC r'//.e'/t. C— L/ ✓�- '��
ADDRESS
/V 22.. /2 .6 Ch 1 /' ? eA-
PHONE
DESIGNER
5 ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
PHONE
ZIP
TO
❑ ALT. 0 AD'N. r' RPL.
O PLMB. •MECH. 0 M.H.
O MVE.
O POOL
0 OTHER
Size of Parcel Zone Classification
Type Const.
Occupancy
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor Upper Floors Garage Area
Area of Decks
Finished Basement
Storage
Unfin. Basement
No. Baths
No. Stories No. Rooms No. of Dwellings
DESCRIBE WORK
•
VALUATION
9.
SOURCE
OF
UTI LITI ES
GAS
ELECTRIC
WATER
CERTIFICATE
of EXEMPTION
Enum. Dist, I Location (Area)
Req'd.
Rec'd.
Not Req'd.
SEWER
Ownership
Public ❑ 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 APPLICATION
SIGNATURE OF APPLICAN,211�i'P`�, :Zy
SPECIAI APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu" g T nician
oory
#g_</f7/r-,/-/ , 'JZ , /-4'/7 L-,` .1v/2 J'✓'
/// e'o TL
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
04* *1700
* 1 7.00
* 1 7,006
A *0.00 0
26992
04--12-82
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0144 2 8:2.
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DAT. E ISSUED
270,02
PERMIT NO.
*17,000.