1980, 10-01 Permit: 80B-1216 FurnacePLAN NUMBER
C"L
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
JOB ADDRESS
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
3
4.
OWNER^
ADDRESS
CONTRACTOR
Cl
PHONE
ZIP
Actual Set Backs in Feet
North (South East 'West
PHONE
ciC -
Size of Parcel I Zone Classification
ADDRESS
DESIGNER
ZJ,p
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
0 BLD.
❑ PLMB. MECH. 0 M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8. L� � �a."3. t�
Enum. Dist.
ILocation (Area)
Req'd.
Rec'd.
Not Req'd.
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
X
WATER
SEWER
Ownership
Public ❑ Private 0
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 APPLICATION 2"
SIGNATURE OF APPLICANT 1'L -t -Z
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
ilt flit ies
Pians Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
jU <)
TOTAL $
04* *700
*7.00 to -
*7006
A *0,00
12052
10-01-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
100 1'--8'0' 12.16
* 7, 0 0 Cl.
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL