1980, 11-17 Permit: 80B-3787 FurnaceAPPLICATION/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
1. L r °BLOC �SUBDIl/ipV(SYO4
2.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER ¢
3. tl TALA (7.744 Pi1LJ
A DRES
4.
5.
Q'>D s
CO TRACTOR
liil2tE
PHONE
92n-3
ZIP
Actual Set Backs in Feet
North 'South East (West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
DESIGNER
ZIP
Type Const.
Occupancy
Sprinklered
UVes ❑No 0 Req'd. '
PHONE
Valuation Building Area in Sq. Ft.
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
14 -NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 OTHER
0 BLD. 0 PLMB. MECH. 0 M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DE CRIBE WOR
8.a SLG,
ALUATI N
9.
SOURCE 1 GAS
OF
UTILITIES
ELECTRIC
WATER
tSEWER
Enum. Dist.
Ownership
Public 0 Private 0
Location (Ar a)
USE CODE
I hereby certify that 1 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 / / 7- SIGNATURE OF APPLICANT'`_
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Techniclan
AAI4/ a.tsz&.
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
1
Mech:
Plan Check
SEPA
012
Mobile Home
Other (Specify)
PERMIT NUMBER '
re) 5-376l
04* *7.00
*7.00 17)
*7.006
A *0.00 a
37&6R
11=17-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
317.8.71 42.0:0a.i'
DATE ISSUED PERMIT NO. TOTAL