1980, 08-28 Permit: 80-9261 FurnacePLAN NUMBER
APPLICATION/ PERMIT
�/ PERMIT NUMBER
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SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
SATE '1 A
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
' ?'
-
JOB ADDRESS
S
LEGAL DESCRIPTION — SEE ATTACHED
1./s1f ,LOLL
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LOT
BL5-ff7B1DIVISION
PARCEL NUMBER/S
I
2.
t)
OWNER
PHONE
3. -DR Lt r
4?-X91—?21j
ADDRESS
ZIP
Required Set Backs in Feet
North South East West.
CONTRACTOR V
PHONE
Size of Parcel
Zone Classification
c "
4. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
ly--
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I
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
OWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
TYPE ❑ NEW ❑ ALT. ❑ AD'N. XRPL. ❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7, OF
OTHER
CERTIFICATE
Req'd.
Recd.
Not Req'd.
El BLD. ❑ PLMB. MECH: ❑ M.H. ❑ POOL
WORK
of EXEMPTION
DESCRIBE WORK
8 71F!�� FEES COLLECTED
"A
VALUATION Source
GAS ELECTRIC WATER SEWER
of
9. utilities
yam✓
"iY` Single $
_
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 Building
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.
Plumbing
DATE dO
SIGNATURE '
-2 Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D.
RECD. Plan Check
Env. Health
For gas;
SEPA
Planning
PIPE SIZES: 0
Fire Marshall
Mobile Home
PIPE LENGTHS: .20"
Co. Engineer
Other (Specify)-
Specify)BTU'S:
BTU'S:/S
Utilities
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist
THIS B COME PERMIT.
!') „ 6.
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