1982, 10-04 Permit: 82A-9014 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
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK ISUBDIVTSIOf
PARCEL NUMBER/S
OWNER /)_ -
ADD ESS
CO N=& ACTOR4.
ADD
L?
5.
DESIGNER
PHONE
ZIP •
Actual Set Backs In Feet
North (South
East
West
P ONE
f�-P'7PLS L
Size of Parcel Zone Classification
PHONE
Type Const.
Occupancy
Sprinklered
Oyes 0No 0 Req'd.
Valuation 1 Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
EW 0 ALT. �0,(AD N. 0 RPL 0 MVE.
0 BLD. 0 PLMB. .KY MECH. 0 M.H. 0 POOL
0 OTHER
Area of Decks
No. Baths
Finished Basement
No. Stories
No. Rooms
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Reed.
Not Req'd.
8.
9.
DESCRIBE WORK
/a ,E-tt)
VALUATION
,go__LaLd
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0Private 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
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
PlaSiting
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. / o --St
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
//!:,
PERMIT NUMBER
04*
A
901.32
1'0=04-82
2 6479.
*1400
*14.006
*00.0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
I 'iC a
C
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED '
9'014t .44:002 ie
PERMIT NO. TOTAL