1980, 01-21 Permit: 80-384 FurancePLAN NUMBER APPLICATION/ PERMIT
PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 -COPIES
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
n
OWNER ^ PHONE
ADDRESS ZIP Required Set Backs in Feet
1'3RJ
q North South East West
CONTRACTOR PHONE Size of Parcel Zone Classification
4.
ADDRESSq ZIP Type Const. Occupancy Sprinklered
t • � (.1 ! C 71 2 CJ ( ❑Yes []No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5.
ADDRESS ZIP DWL Area Basement Area I Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE [� NEW ❑ALT. ❑ AWN.❑ RPL. ❑ MVE.
7, OF ❑ OTHER
El BLD. ElPLMB. R MECH: ElM.H. ❑POOL CERTIFICATE Req'd. Recd. Not Req'd.
WORK
of EXEMPTION I
DESCRIBE WORK _ FEES COLLECTED
8.
VALUATION Source GAS ELECTRU WATER SEWER
of
9• Utilities X A 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
Plumbing
performance of construction.
DATE t 3-- 'RJ SIGNATURE—u k Jl �2�-% _ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
i
Planning
i
Fire Marshall Mobile Home
Co. Engineer Other (Specify)
Utilities TOTAL $ C? 0
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE.
SEPA Checklist THIS BECOMES A PERMIT.
DATE OFFICIAL