1980, 11-21 Permit: 80B-4083 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
,. N-
LOT BLOCK SUBDIVISIO
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNE5
3.
ADDRESS
Gwn.90v✓ vV
r; 2 -?5/e
Zip
CONTRACTOR
4. e NeYtD /fh—t
ADD ErSS
i7 57
r7272,T
Zl� z as
5.
DESIGNER
•
PHONE
ADDRESS
ZIP
Actual Set Backs in Feet
North 'South East - 'West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Yes DNo 0 Req'd.
Valuation Building Area in Sq. Ft.'
Main Floor Upper Floors Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Lint in. Basement
EW 0 ALT. 0 AD N. RPL. 0 MVE.
0 PLMB. ,F1.4NIECH. 0 M.H. 0 POOL
0 BLD.
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
$ DESCRIBE WOR -- / Ct J'p -^
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0Private 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
%/ R
2
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Check!
es=;411)1Na.
SIGNATURE OF APPLICANT
S'ECIAL CONDITIONS:
%Op opo
/
7f
• 4' S i
N
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
'FEES COLLECTED
Single $
Building
Plumbing
30_5r;
ems,
Mech. e e
IO o�
Plan Check r I
SEPA
Mobile Horne
Other (Specify)
TOTAL
PERMIT NUMBER
bo w✓ - 4-085
04* *1200
*1200 N
*12006
A *000 8
r�.
4082
1:1 41-80
2 647'9.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
.yi i
4'O a 3'Z *:1 20 U a:J
DATE ISSUED PERMIT NO. 1 TOTAL
0-
0
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