1980, 01-21 Pemrit: 80-392 FurnaceAMBER APPLICATION/ PERMIT
PLA
PERMIT NUMBER
C:6
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
C)r
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
/ * .1
JOB ADDRESS
Vic;
LEGAL DESCRIPTION — SEE ATTACHED
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LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
I
OWNE 1
HONE--
3.
93116 –53a
ADQD{�2ESS �� 1 } ►O� t'�1
ZIP
Required Set Backs in Feet
,`'•
Y"�\ C)` ) +1 '� LYt� Ci
North South East West
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PHONE
Size of Parcel
Zone Classification
'N `T,RAPCT,OR
4. ADDRESS
ZIPZ(IIP (�,
0
Type Const.
Occupancy
Sprinklered
G ( C.-) q I 1 --�
1? f
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
—
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE .NEW El ALT. ❑ AD'N. El RPL. 1:1 MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
%, OF
CERTIFICATE
Req'd.
Recd.
Not Req'd.
1:1❑OTHER
BLD. ❑ PLMB. �ECH: ❑ M. H. El POOL
WORK
of EXEMPTION
DESCRIBE WORK
8 FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
of x
9. Utilities
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
DATE / ' _– G ' SIGNATURE ���L �� �� �'� Mech. L'
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
c
c
Planning
_ L
Fire Marshall Mobile Home
Co. Engineer Other (Specify)
Utilities
o v
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
DATE 1`..L -$OFFICIAL