1981, 11-04 Permit: 81B-1474 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS H \RD 'r0 MAKE 3 COPIES
JOB ADDRESS �c?
/ 3
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3 C/e':>---✓ ,e%/S t
ADDRESS /4-/
PHONE
5%AFf-> c3
ZIP
Actual Set Backs in Feet
North 'South
East
West
CONTRACTOR
4.ADDRESS Df ' E./y 62.4/7-, fr/e /i �.�, r'f /c"c 7
r f 3 7/ c b4. trNet
DESIGNER
5. ADDRESS
PHONE
Size of Parcel Zone Classification
CHANGE OF USE FROM
6.
TO
ZIP
PHONE
ZIP
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
O MECH.
O RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Type Const.
Valuation
Main Floor
Occupancy
Upper Floors
Area of Decks
No. Baths
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8./sV5/t// f/kP i+. -epee
VALUATION SOURCE G S ELECTRIC WATER SEWER
Enum. Dist.
OF
9. UTILITIES
No. Rooms
Req'd.
Location (Area)
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATIC'" /0 ` 30 -
•
SIGNATURE OF APPLICANT -ey-'
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Build ng Technician
SPECIAL CONDITIONS:
F' e / /J4.,,,
f
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Storage
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan eck
lUvia
SEPA
Mobile Home
Other (Specify)
TOTAL $ ee
PERMIT NUMBER
ek6;414
* 14.0,0 5
* 1 4.0.0
A *0.00
147,38
1.1-04-81
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8'
147.42 *1400'2F!
DATE ISSUED PERMIT NO. TOTAL
Fll F COPY