1980, 01-05 Permit: 11-05 Permit: 80B-3267 Furnace'PLAN NUMBER
jll :
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3.COPIES
JOB Alf?
1. / 7/a
I510N
2.
LOT
BLOCK
SUBDI
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
5.
OWNER. i/ ^ % a /J
�/J,/{'/,LAG//G/G��
PHONE
9�s ysz/
PARCEL NUMBER/S
` S7a
ADDRESS
cCONT A 4atiAt/z1,
PHONE
yn �/ao
Actual Set Backs in Feet
North (South
East
(West
Size of Parcel 1 Zone Classification
ApaRESS
la -776
DESIGNER •
71,2//0 1
Type Const.
Occupancy
Sprinklered
Oyes ONo 0 Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. 127MECH. 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.
D SCRIB OR
�iCc�C cre et L f
8.
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATE�
Enum. Dist.
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 /0 f f o
SIGNATURE OF APPLICANT , e �ihU
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Exams
ne
SEPA Check hs
B,Idin• T hose
SPECIAL CONDITIONS:
' PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
t.oc
TOTAL $ /`OG
PERMIT NUMBER
1401-3-R(5:7
04* *7.00
*7.00 L
*7.006
A *000
326'62
01-15-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE;
THIS BECOMES A PERMIT.
I..
I1itn: 18;0;
DATE ISSUED PERMIT NO.•
7,p.p S�
TOTAL -