1982, 11-12 Permit: 82B-911 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.
JOB ADDRESS
N. 1103 BURNS gcAj)
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
PARCEL NUMBER/S
OWNER
3 STaitEM L, N R:P3 &o �vl
ADDRESS
1.1. 1103 BUgNS Ro
4.
CONTRACTOR
ADDRESS
PHONE
`21222. -2015
ZI P
DESIGNER
5. ADDRESS
PHONE
ZIP
PHONE
Actual Set Backs in Feet
North 'South
Size of Parcel
East 'West
Zone Classification
Type Const.
Occupancy
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor I Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
�EW ❑ ALT.❑AAD'N. 0 RPL. ❑ MVE.
0 BLD. ❑ PLMB. R. MECH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
DESCRIBE WORK
8. t•CDOP rutzt Ac1E.-
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Enum. Dist. I Location (Area)
WATER
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 regulatin! .nstruction or the
performance of construction SEE REVERSE SIDE FOR REQUIRED INSPECTION&
DATE OF APPLICATION 11 `a
I � SIGNATURE OF APPLICANT �11. er
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
/-A-14f,
Other (Specify) (0 X)
TOTAL
$
PERMIT NUMBER
c .Z$- 1 11
4* *20.00
*2000
*20.006
A *000 S
9 1, tJ
11-12-82
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'1' 2-82
DATE ISSUED
91.115 *20,00°
PERMIT NO.