1981, 11-16 Permit: 81B-1831 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDI'NG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES'- PRESS HARD TO MAKE 3 -COPIES
JOB ADDRESS
1. /sy
LOT BLOCK SUBDIFIA"6n✓
2.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. /teleaf Bat4et-
ADDRESS
E/5 5'05 fteico`
PHONE
9a11 -y - Ore
ZIP
99a/ 4
Actual Set Backs in Feet
North 'South East West
CONTRACTOR
4.
A I./t/ ac:.,b /7> fy /yr- Y S/?t / L c
ADDRESS /
E /.2 %/ C l Y vii v
PHONE
9r2Y-A/oa
Size of Parcel Zone Classification
ZIP
99a /C.
Type Const.
Occupancy Sprinklered
❑Yes DNo 0 Req'd,
5.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE 0 NEW
7. OF
WORK 0 BLD.
DESCRIBE WORK
TO
Area of Decks
Finished Basement
Unf in. Basement
❑ ALT. 0 AD N. 0 RPL. ❑ MVE.'
❑ PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
8. /%, g %/H GR `•r
VALUATION GAS
•
9.
SOURCE
OF
UTILITIES
ELECTRIC
WATER
Enum. Dist.
e
Location (Area)
SEWER
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 INSPECTIONS
DATE OF APPLICATION I/'/ u2 - / SIGNATURE OF APPLICANT
SPECIAL APPROVALS ' SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fl re Marsha
Co. Engineer
Utilities
Plans Examiner
SEPT\ Checklis
Building Technician
C:
s- " •S a. 1'e— Fti c 7 Pez.7.--sG-N
• PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. /O. UO
'A V. UG
Plan eck
SEPA
Mobile Horne
Other (Specify)
TOTAL $ %9Oa
PERMIT NUMBER
&t1s 1$31
04* *1400
* 1400 171
* 14006
A *GOO
18308
1;1 -1 6-81
g, 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
AlL4'6'1r8"11 1 1'83.12 *1400;°iJ - ,
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED •
PERMIT NO.
TOTAL