1980, 10-07 Permit: 80B-1523 DuctworkAPPLICATION/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
LOT
BLOCK
SUBDIVISION
3
4.
OWNER
ADDRESS
CONTRAC
ADDRrrESS
DESIGNER
l J"" Y%i.J
C4'
La-earl-
PHONB
ZIP
ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZI
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
a c7
PHONE
ZIP
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const.
Valuation
Occupancy
East
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Main Floor
Building Area in Sq. Ft.
Upper Floors I Garage Area
Storage
TYPE
7. OF
WORK
9.
❑ NEW
❑ BLD.
DESCRIBE OR
VALUATION
ALT.I�AD'N. 0 RPL. ❑ MVE.
0 PLMB. TJ`MECH. 0 M.H. 0 POOL
S.URCE
OF
UTILITIES
GAS
ELECTRIC
WATER
❑ OTHER
SEWER
Area of Decks
No. Baths
Finished Basement Unfin. Basement
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
Enum. Dist. Location (Area)
Ownership
Public ❑ Private ❑
No, of Dwellings
Req'd. Rec'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 INSPE NS
DATE OF APPLICATION 10-4" PO SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Healtn
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building T ician
i`.
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
4.°3
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
M
PERMIT NUMBER
t3 -1s;-,5
04* *7.00
*7.00 V)
*7.006
A *0,00
15222
10-07-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10,-{07'8 G
DATE ISSUED
1 52,3 g
PERMIT NO.
*7,00°) —
TOTAL