1980, 07-28 Permit: 80-7775 Furnace',}PLAN N!JMBER
• i
(1!f
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
2.
JOB ADDRESS
BLOCK
Gr:A'/Os'!
SUBDI ISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
3. C/
ADDRESS
f/rL'l�li•tr-/
PHONE
PARCEL NUMBER/S
ZI P
Required Set Backs in Feet
North 'South East ;West
CONTR5CTOR
4.
ADDRESS
1t/ C(,.—
DESIGNER
5' ADDRESS
•4,!Av
5. /`�.s-r
PHONE
Size of Parcel Zone Classification
ZIP
1p,, 37
Type Const.
Occupancy Sprinklered
Les No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
1 Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
®MEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
cif
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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.
DATE 7 3 / SIGN • UR
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAIf'. FOR ,(7C34.4-4:61
APPROVED ! ...'Alt'vE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
Yo -7773
DATE 7" z�
E
777.48
07-28-80
g 6479,
*7.00
*7.00 th-
*7.006
*0.00 S
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS.J3ECOI ES A PERMIT. 7 .7 7 5 Z
*7.00