1980, 12-19 Permit: 80B-5094 FurnacePLAN NUMBER
c/
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (5091 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE -4 COPIES
1.
2.
JOB ADDRESS�/jQ
LOT BLiCK' SUBDI
i /
IS ON
OWNER 14:441/241_...
�nLL �I /
3. '/'Y/X.r j a 7114
ADDRESS
7✓(A a /zi ..e,a ,Q.rt. s1.p ..�t.�c_
CTRACTOR
_OS
AD R^ES-S
DESIGNER
4.
5.
PHONE
/.26 —t24D6
ZIP
ggza6
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East 'West
Size of Parcel I Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Oyes CNo 0 Req'd.
PHONE
Valuation I Building Area In Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area r Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Split Entry
Split Level
Rancher
0 NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 BLD: 0 PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Reed.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this applica ion 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.
DATE /c2 -/9-FD SIGNATURE %
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
r,
77 o-^ -a.
13 /Z' ° 40 -s -k,
/-2-/9-.RD
DATE OFFICIAL
FEES COLLECTED
Single
Building
•
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 70
DATE
PERMIT NUMBER
gala -S69$
04*
A
509.38
*7.00
*7.00 5
*7.006
*0.00 S
1'2=19'-80
6479.j1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A'PERMIT.
1.2i1115i-I801 5;09;41-
APPROVED FOR ISSUANCE -