1981, 11-03 Permit: 81B-1432 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3•COPIES
JOB ADDRESS
'• Z �I
2. l TON SS�U N �;,...:.r
Lo-�)3 L'UCn' oU TSTON
LECAI DESCRIPTION — SEE ATTACHED •
OWNFR�
t
<
3. ADD RE55' {{
P ONE
o74I3
ZI
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South [East 'West
CONTRACTOR
4.
ADDRESS
/3.-4f /(el AfrJ
PHONE
Size of Parcel I Zone Classification
5.
DESIGNER
ZIP
y9 701
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd.
Valuation Building Area in Sq. Ft.
•
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE t&,NEW
7. OF
WORK 0 BLD.
O ALT. 0 AD N. 0 RPL. 0 MVE.
O PLMB. ,<MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
9.
DESCRIBE W�f K1n // y/,
at
eteci att.,
oestaa
VALUATION ELEryf RIC
SOURCE
OF
UTILITIES
Gas
WATER
SEWER
Enum. Dist.
Location (Area)
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 INSPECTION
DATE OF APPLICATION /017-'74#4, "-ren SIGNATURE OF APPLICA Pe, ,ali� ��I'LJ
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B ing T chnician r..M uy
SPECIAL CONDITIONS:
yeova eru-
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
•
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
et a
04* *1/100
* 1400
* 14.006
A *000
14242
11-03-81
2 6479.
04* *4.00
*400
*4006
A *000
1 431
1t1 =03-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
112.5g
f i,1 25 Z
DATEJS UED .1 oil • PERMIT NO:
2
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