1980, 03-26 Permit: 80-2689 Furnace,PLAN NUMBER
°L^
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER -yam♦-,
DATE \
e4� 7.
c.
f ? P r`
t- 4 '7 n
DESCRIBE WORK FEES COLLECTED
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
VALUATION Source GAS ELECTRIC WATER SEWER
JOB ADDRESS
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
LEGAL DESCRIPTION — SEE ATTACHED
C
c
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
Plumbing
performance of construction.
LOT
BLOCK
PARCEL NUMBER/S
2.
DEPT. REQ'D. RECD. Plan Check
ISUBDIVISION
I
Env. Health
SEPA
Planning
OWNER f r
C
�I"�
\Y_
Co. Engineer Other (Specify)
PHONE
Utilities
3.
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist THIS BECOMES A PERMIT.
ADDRESS
r)ATF_7 (I OL'n FFICIAI
ZIP
Required Set Backs in Feet
Nortli` South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
c Ll/L
_
�. — ��•�'
4'
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
DWL Area
Basement Area
Garage AT7
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE KNEW
1:1 ALT. ElAD'N.
1-1 RPL.
ElMVE.
7,
OF \
❑ OTHER
❑ BLD.
❑ PLMB. A MECH:
❑ M.H.
❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
PERMIT NUMBER -yam♦-,
DATE \
e4� 7.
c.
f ? P r`
t- 4 '7 n
DESCRIBE WORK FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
Single $
1 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
Plumbing
performance of construction.
3 d — C'
DATE SIGNATUREM ech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist THIS BECOMES A PERMIT.
r)ATF_7 (I OL'n FFICIAI