1981, 11-09 Permit: 81B-1595 Conversion BurnerPLAN 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
LOT
2.
IRS I7`'S at4-aWO'
BLOCK (SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3 OWNER StICAM u.a i 11 kVkn-
' ADDRESS /�
5 vIn e -
'CONTRACT
liennu
4.
ADDRESS 2,cx_ 1i lgrz Vt
DESIGNER
ZIP
PARCEL NUMBER/S
Actual Set Backs in Feet
North - • (South
East
'West
448
Size of Parcel . i Zona Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
• ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6. 011
TYPE
7. OF
WORK
TO
Gres
Area of Decks
Finished Basement
Unf in. Basement
❑ NEW CJ ALT. �❑" AD N. 0 RPL. ❑ MVE.
❑ BLD. ❑ PLMB. IDS1 T H. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
9.
DESCR.IBg.WOR 1
VALUATION
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 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 INSPECTION
/v �,rt/f'✓ l��'`I �.C.GC/CI
DATE OF APPLICATION , - 4EV8 / SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
BuildinggjTechnician
SPECIAL CONDITIONS:
/bp,000 gni.
/ct-/" 7f_.1/z4
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 $ %B'Uv
PERMIT NUMBER
& ita - tsa.5
04* *1800
* 1800 rrn
* 18006
A *000
159.42'
1'1-09-8.1
2. 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11 =019'7 8
: I
1'59,5=. *18.00,22Ft
DATE ISSUED PERMIT NO
TOTAL