1980, 01-22 Permit: 80-0436 FurnaceG
PLAN 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 4 COPIES
1.
2.
JOB ADp LOC D �/ , ` e—c/ '�\
LOT S BLOC 5 B IV ION
LEGAL DESCRIPTION - SEE ATTACHED
3
4.
AW L
ADD ESS
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ADDR
5.
DESIGNER
PHONE
%ds/yay2-
ZIP
PARCEL NUMBER/S
PHONE
yg7ff 2<
ZIP
9802 PHONE
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 (Building Area i Sq. Ft.
ADDRESS
ZIP
OWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
❑ NEW
❑ BLD.
❑ ALT. 0 AD N. 0 RPL. ❑ MVE.
o PLMB. T MECH: ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
'VALUATION
9.
6t -c -v
Source
- of
Utilities
GAS
ELECTRIC
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 or local law regulating construction or the
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
• Planning
Fire Marshall
Co. Engineer
Ut ll iti05
Zone Clearance
SEPA Checkllst
SP EC I[yi CONDITIONS
fr
/
r/
/O7 -q
•
DATE
34- 3 t Co Co
DiSIG L t
APPROVED FOR 1S UANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
)8.00
TOTAL $
DATE
PERMIT NUMBER
e oc -&4-3a'
/-�
04* *1800
* 1800 N
* lane,
E *000 8.
4358
0122'-80
6479.
4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. i, r
Ol:-q:g..;:g'p 43,62
18.00.c?.
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