1980, 12-17 Permit: 80B-4955 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
1.
2.
3
JOB ADDRESS
c:.3C7 r .
LOT BLOCK SUBDI ISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
ADDRESS
&"4-'2-1 C".ALL:41.0
4P -c/7/
ZIP
Actual Set Backs in Feet
North 'South East 'West
CONTRA TOR
Ltir>J ,LDnc,
4. AD ss
cod
DESIGNER
rJ. ADDRESS
PHONE
3c/:44 is
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
9.
TO
ZIP -
PHONE
ZIP
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy
Main Floor
LJ NEW
❑ BLD.
DESCRIBE WRK
VALUATIO
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
O PLMB. i "MECH. ❑ M.H. 0 POOL
SOURCE
OF
UTILITIES
0 GS
ELECTRIC
0 OTHER
WATER
SEWER
Upper Floors
Area of Decks
No. Baths
Sprinklered
Oyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
Req'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 INSPECTIO
DATE OF APPLICATION /07-15— gor)
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildin Technician
7iPi "4
a°)al
ri A/2
IOC, I OC)O ,.,-171.A.
PERMIT IS NONTRANSFERABLE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
L pC
Plan Check IFC)°,
flA
SEPA
Mobile Home
Other (Specify)
TOTAL $'p (1)
PERMIT
4* *1200
* 1200
* 12006
A *0.00
495.42
12-17-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12,-1 7,;_8
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
4955 *12000 -.1
NO. TOTAL