1981, 09-29 Permit: 81A-9981 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
JOB ADDRESS.
1. /3/9 A! 27V
LOT
2. •
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. a/C4471/
ADDRESS
/ /9 A4 .Z-L771,A/
CONTRACTOR
4. ox4/A/4-,e F---Vge&_-_- 7r//4-ziZV
AD RESS
ilfrEZ
PHONE
ZIP
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const.
Occupancy
East
'West
Zone Classification
Sprinklered •
0Yes ONO 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
aNEW
0 BLD.
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
O ALT. 0 AD N. g'RPL.
o PLMB. MECH. 0 M.H.
O MVE.
O POOL.
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.ie4'PZ/9 /r/Zei14160--- /45f/Alo.e
74e•ek9
Enum. Dist.
ILocation (Area)
• VALUATION
9.
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 INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Engineer.
Utilities
Plans Examiner
SEPA Checklist
g Te cian
SPECIAL -CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
• Plan Check
SEPA
Mobile Home
Other (Specify)
Z'd
TOTAL $
PERMIT NUMBER
ibtA - T781
• 04* *1600
* 1600
* 16008
A
-99802
2 6„479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A.PERMIT.
V19)H811'
DATE ISSUED
)
998.'1 k1.6.'0 '0 ri2 -
PERMIT NO. jt, • TOTAL