1980, 01-21 Permit: 80-390 FurnaceFLAN 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 4 COPIES
JOB ADDRESS
1.
SI () Yti1C>�,�,� _ -
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
2.
I
OWN
PHONE
3. CLit
ADDRESS
(
ZIP
Required Set Backs in Feet
f
-
/f) ( A
North South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4.
ADDRESS
Z P
Type Const.
Occupancy
Sprinklered
C '!
L- -)
❑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
Split Entry
Split Level
Rancher
6.
ITO
TYPE El NEW
1:1 ALT. 1-1 AD -N. 1:1 RPL.
ElMVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7, OF
❑ OTHER
1:1 BLD.
❑ PLMB. ❑ MECH: ElM.H.
1:1 POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
8 CA -2 —. IA -6 ,� �� --Y—� <L
FEES COLLECTED
VALUATION Source GAS ELECTRICO WATER SEWER
of y "
9. utilities '\ l� 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
performance of construction,Plumbing
DATE
1
DATE ('^ 13U SIGNATURE— l �� ��"�'10_� Mech.
SPECIAL APPROVALS
DEPT. REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SPECIAL CONDITIONS:
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTA L $ �" z
' A PERMIT NUMBER
P ` �c
DATE��(�
3 c; ,
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
,�. �Q� 11 1 s C J ;r �)� -
DATE �C- 1YJOFFICIAL _. _ _