1980, 12-23 Permit: 80B-5165 Gas ConversionPLAN 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
3. OWNER
m f�
ADDRESS
C�RACT
4. 1 Ie� tlV-t- CX nM-F/I_
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
`ADDRESS
)) Cl 77 , (42 h)
DESIGNER
5.
ZIP
Actual Set Backs in Feet
rth 'South East IWest
e of Parcel' 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Dyes ❑No 0 Req'd.
PHONE
Valuation
Building Area in 5q. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CG '/ USE FROM '
06.
TYPE 0 NEW
7. OF
WORK BLD.
TO
❑ ALT. 0 AD N. 0,RP . 0 MVE.
0 OTHER
0 PLMB. MECH. 0 M.H. 0 POOL •
Area of Decks
Finished Basement
Unf in. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
9.
DESC IBE WORK
fl
IOTV \"l0.)
VALUd
t 'SOURCE
OF
UTILITIES
GAS
Enum. Dist. I Location (Area)
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
I hereby certify that 1 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 co` truction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPEC (ONS 1
DATE OF APPLICATION /0-L2- '4 SIGNATURE OF APPLICANT444 ♦, Ci
SPECIAL APPROVALS
NAME DATE
Env. Health
• Planning
Fire Marshall
Co: Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui1tl� g chnician
ia
sa
SPECIAL CONDITIONS: '
/Q0 oCYo
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
$ /4°'
PERMIT NUMBER
0 W3- S/6.6-
04*
/(oS
04* *1200
*1200
51642
12-23-80
2-6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
;2p 3'';'8'01 5'1631 *1200af2 -
DATE ISSUED PERMIT NO. TOTAL
O
U
UJ
-J