1980, 12-04 Permit: M80B-4445 FurnacePLAN NUMBER
Pi
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 ,t
1. s, 17/00 µJ®iuL
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
3
OWNER
ADDRESS
v& Waci-Oci.i'UCAJ
PHONE
9Q& -7�s
PARCEL NUMBER/S
ZIP
6190/0
Actual Set Backs in Feet
North (South East (West
CONTRACT°
4' ADDRESS _l µ�f
•
DESIGNER Y�
L`Jr /rn�
5.
PHONE '
&a
Size of Parcel' 1 Zone Classification
ZIP
%G%a0 2'
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd.
Valuation I Building Area I Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
TYPE
OF
WORK
NEW
0 BLD.
O ALT.
O PLMB.
0 AD N.
RI MECH.
O RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8. DESCRIBE WORK \ri‘D loan jl _ c)
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
ATER
SEWER
Ownership
Public 0 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 T REttVERSE SIDE FOR REQUIRED INSPEC3S
T\TJD
DATE OF APPLICATION /1— a - Pa SIGNATURE OF APPLICANT \ 1n at, ry -Kcid `y
SPECIAL • APPROVALS
)NAME DATE
Env. Health
Planning
Fire,Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildiin%n Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. �•�
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
505 411S
04* *700
*7.00
*7.006
A *009 R
44442
12-04-80
1 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11,2[7.13:141,-/..811
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
•
4:
44t5'Z `* 7...0,M 2.0 –
PERMIT NO. TOTAL