1981, 11-23 Permit: 81B-2082 FurnacePLAN 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 3 -COPIES
JOB ADDRESS
4721/T /oQ917 g ctrl Rd.
I B O K SU DTVI
2.
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3. M I Kr of-r6S'
ADDRESS
�f //7 /a M/N7ti
CONTRACTOR
4-N 6X-50/U's h7-6 g R/c
e 81/6- DnmicisF/a-cL)
4.
5.
DESIGNER
PHONE
ladG4S7e
PARCEL NUMBER/5
ZIP
y7ao6
P ONE
gas -on, 0
ZIP
giaoC>
PHONE
Actual Set Backs in Feet
North ISouth
East
'West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
UVes 0No 0 Req'd.
Valuation I Building Area i 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 $ NEW
7. OF
WORK 0 BLD.
O ALT.
O PLMB.
0 AD N.
MECH.
❑ RPL.
O M.H.
❑ MVE.
o POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. o 'Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. A/Ew („As
VALUATION
9.
SOURCE
OF
UTILITIES
z,0 it D uCr- w o -L/(
GAS
X
ELECTRIC
Enum. Dist.
Location (Area)
WATER
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 8 SIGNATURE OF APPLICANT Com[/ 444Yi
SPECIAL APPROVALS SPECIAL CONDITIONS: ./
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
64.s - /as, o -v -o Brit q --7,5-0 -
6ebod a. cm
/0, U'a
2 9 . so
11
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
$1�
PERMIT N1t4CBER-,
04* *19.00
* 19.00 to
* 19.006
A *000 a
20-&1 2
..i1-23-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�, 3t
i . 8 �1
A.
,f1=:2 ,
DATE ISSUED
208.22 *19.0Q, -
PERMIT NO.
TOTAL
0
U
LL