1980, 06-04 Permit: 80-5345 FurnacePLAN N UMBBEERCtiny n
t V W
APPLICATION/PERMIT
SPOKANE COUNTY -.BUILDING CODES DEPARTMENT
NORTH B11 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
2.
Le 1 3 S - co --4&.R Al-
BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3
4.
5.
CONT ROS C(T O R
ADDRESS
DESIGNER
PHONE
ZIP
PHONE
ZIP
PHONE
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South `East (West
Size of Parcel 1 Zone Classification -
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
Valuation l Building Area i 5q. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
0 ALT. 0 AD N. 0 RPL. 0 MVE.
BLD. ❑ PLMB. ...12tMECH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
- CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. - ,_S K Lv LU �4AkA �`
VALUATION
9.
Source
of -
Utilities
GAS
ELECTRIC
2( k
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 r local law regulating construction or the
performance of fO�constructtiionn.
`CI
DATE t) V SIGNATURE '"Th2iQsrE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
41I-11
DATE - 5- DOFFICIAL am)
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
U-
Mech. II
Plan Check
SEPA
Mobile Home
Other (Specify)
GL.
TOTAL $
•
DATE
PERMIT NUMBER
M531A5
04* *7.00
*700 tb-
*7006
E *GOO 8
53448
06=04'-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. •� ^ z 0 a A•F
13tiY10'44. 8 0 i