1981, 10-13 Permit: 81B-0610 Conversion BurnerPLAN 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
LOT
� ? no>3 }M Al 1\1
B z O K SUBDT ISION
2.
;LEGAL DESCRIPTION - SEE ATTACHED
OWNER ��//��� � `l�
3 ort
� 1� 1a
ADDRESS
M'
CONT RACrR 041
r
ADDRESS � sct 3 ahs AL
PARCEL NUMBER/S
etIONE
reCo —c
ZIP Actual Set Backs In Feet
North 'South
East
(West
PH�Size of Parcel Zone Classification
(5
ZIP Type Const.
Occupancy
Sprinklered
Oyes DNo 0 Req'd.
5.
DESIGNER
PHONE
Valuation • (Building Area In Sq. Ft.
ADDRESS
ZIP Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
tit(
TO
Area of Decks
Finished Basement
Unf in. Basement
❑ NEW L'TA LT. �0 ADADN. 0 RPL. 0 MVE.
0 BLD. 0 PLMB -CJ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WOR)
s. ,_j�,(S � � C' revs tOki P e1
VALUATION SOURCE OF GAS ELECTRIC
jv
9. UTILITIES J _Public O Private 0
CERTIFICATE
of EXEMPTION
Enum. Dist.
Req'd.
Recd.
Not Req'd.
Location (Area)
WATER SEWER
'Ownership
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 INSPECTIO
DATE OF APPLICATION 9 k SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu ingThnician
SPECIAL CONDITIONS:
/00 wt 'r
20'-,y
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 1�v.CJa
PERMIT NUMBER
i31T3 - OCcIo
04* *1800
*1800 to -
*18006
A
*GOO
-60.92
10-13-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'11 to 31In'811'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
6L02 *18.00aie. -
•PERMIT k10. TOTAL