1980, 04-03 Permit: 80-3055 FurnacePLAN.NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
iso — 3055
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1.
2.
S, 3 6a / Fax
SUBDIVISION
LOT
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. w. R.. S. /'.,.-s t (I,
ADDRESS
inn G. /G _Snit1. 4-12,
PHONE
9z -Y442 -
ZIP
99aoer
C�1tONTT/RA/CTOR F �( free
.�
4. /70/Gr Gt/-//y f/n7//Ay fGree//r'(U/ i,..-4-
ADDRESS
stADDRESS / /
£/x 7/n /v`I v.. -a rezAt..r, Y- /.>/!C
DESIGNER 7 (/
5' ADDRESS
PHONE
9??-a•/Oo
ZIP
9nia /G
PHONE
ZIP
Required Set Backs in Feet
North 'SouthEast 'West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Ves ONo 0 Req'd.
Valuation I Building Area In Sq. Ft.
,DWL Area I Basement Area Irll Garage Area Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE 0 NEW
7. OF
WORK 0 BLD.
O ALT.
❑ PLMB.
0 AD N.
OIMECH
O RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRI 3E WORK. ,,LL
8. /.' / // uf/* g t//
irAI /i7;4./eL/C
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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.
DATE `/—/ V.d SIGNATURE
DEPT_
SPECIALAPPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DAT E'l`-11D OFFICIAL 471 `1r1 AK/se .Q
APPROVED FOR ISSUANCE
' FEES COLLECTED
Single $
Building
Plumbing
Mech.
elect -
Plan Check
3-"O
y:O G/
SEPA
Mobile Home
Other (Specify)
TOTAL
$
04* *7.00
*7.00 ra
*7.006
E *000
30542
04=03=80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. '
0i4$t10'311=$'0• 3 0 5:5 z
*7,00aj -