1981, 10 Permit: 81B-1334 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
1.
2.
3
JOB ADDRESS
t{I� C./k,44A�
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
OWNER
mR , ' e -r RA( -c4
ADDRESS
X11 C AF414N
CONTRACTOR
a. tiEATl.l3C-
ADdRESS
PHONE
S-31
ZIP
Actual Set Backs in Feet
North 'South
East
'West
PHONE
539 -51 o
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6. AS
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW 0 ALT. ❑ 'N. 0 RPL.
❑ BLD. ❑ PLMB.CH. 0 M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. ��hi i,tBoi Cf)(? gTU �IaS U�'toAc ,
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
uildiriq Technician
SPECIAL CONDITIONS:
O I4E -A— * 2q3 1
ZS�1 z_
l 1 O^0I
cola.
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ LW
PERMIT NUMBER
1331-1
04* *16.00
* 1600 t7i_
* 16006
A *000
133,32
1030-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
3j: d 1LZ
DATE ED PERMIT NO. TOTAL