1981, 07-02 Permit: 81A-6662 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
JO DDRE$ST i C Lill NJ
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
3
4.
OWNER
p rc - c 14.Ct\
ADD ESS�Q�� /�'\
CONTRACTOR
r 1 3 IL
A D D F�,ES S
V 16a, ci
DESIGNER
5' ADDRESS
PHONE
P
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East (West
P ONE
43-'975
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
Elves ❑No ❑ Req'd.
Building Area in Sq. Ft.
PHONE
Valuation
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
iNEW ❑ ALT.
❑ BLD. ❑ PLMB.
8.
9.
❑ AD'N.
❑ RPL.
MECH. ❑ M.H.
rolAN41/4L-- (e)c) r2i-J)
VALUATION
❑ MVE.
❑ POOL
LI OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
ELECTRIC
SOURCE
OF
UTILITIES
GAS
bf1 f'
I WATER
CERTIFICATE
of EXEMPTION
Req'd.
Enum. Dist. I Location (Area) r
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 regulating construction or the
performance of construction. AEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION_
SPECIAL APPROVALS
NAME DATE
_7'L._
SIGNATURE OF APPLICANT
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SE PA Checklist
SPECIAL CONDITIONS:
(caNrV IIIc.
jv 13 -z ✓ )
•
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
Other (Specify)
TOTAL $ l
rtr<bIVI i i Ivy IVIts.
04* *1800
* 18,00
* 18.006
A *0.00 d
6661
07-02-8,1
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
4 I t
0 flit 81 666, 2z *18,00x1,--, -
DATE ISSUED PERMIT NO. TOTAL
nir (rDV