1981, 04-22 Permit: 81A-3816 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BULL -041G CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 -COPIES
JOB ADDRESS
,. 33:)Gzit
LOT
2.
BLOCK
LEGAL DESCRIPTION — SEE ATTACHED .
SUBDIVISION
PARCEL NUMBER/5
OWNER
3. lt/v
ADDRESS
PHONE
ZIP
4.
5.
CONTRACTOR
O14
ADDRESS
PHONE
4.89-r7 3
{�T�1 v t P5-€ 1 3 3&
DESIGNER`
ZIP
f9:le 7
PHONE
ADDRESS
ZIP
Actual Set Backs In Feet
North (South East 'West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ONo 0 Req'd.
Valuation Building Area In Sq. Ft.
Main Floor Upper Floors Garage Area Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW XALT.
7. OF
WORK 0 BLD. 0 PLMB.
DES RIBE WORK f/�
i
ALUAT 'i. SOURCE GA
OF
9. UTILITIES
0 AD N. 0 RPL.
kMECH. 0 M.H.
0 MVE.
0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION .
Req'd.
Rec'd.
Not Req'd.
Enum. Dist.
M
Location (Area)
ELECTRIC
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%/>t L Ft i
SIGNATURE OF APPLICANT/lr `6
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
o. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
` r
D/
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 $ !Ve d/
PERMIT NUMBER
5.?/4. —SC/(—it
04* *24,00
*24,00 N
*24006
A *000
381.52
04`=22-8.1
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i,
0'4•x'2' '"a'8!r111 3,8;1'6'z *12140 H.
DATE ISSUED PERMIT NO. TOTAL