1981, 07-16 Permit: 81A-7110 FurnacePLAN NUMBER
.1
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
JiZr ADDRESS
LO r1 l LOCK
LOT I BLOCK
OWN,(
iAt
SUBDIVISIO
ADD iE� ,c dim a6 s
)622 14fichi
CONTRA
4. ADDRESS 1�
519)
PHONE
94.- 309
e39 -7 -ice
PHONE
LEGAI.DE.SCRIPTION — SEE ATTACHED
PARCEL NUMBER/5
Actual Set Backs in Feet
North (South East: 'West
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 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.
TO
Area of Decks
Finished Basement
Unfin. Basement
7.
TYPE
OF
WORK
LJ NEW 0 ALT. �❑ AD N. 0 RPL. 0 MVE. LY
0 BLD. 0 PLMB. MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRI
S. DVAL�T�I�ra FC.0 \{sOURCE A`5/ Hit-JRIC
OF
9. UTILITIES
Enum. Dist.
Location (Area)
WATER
SEWER
Ownership
Public 0 Private 0
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 INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Check`
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED -
Single $
Building
Plumbing
Mech. .
Plan Check
SEPA "
Mobile Home
Other (Specify)
TOTAL - $ I�r
PERMIT NUMBER
biA- -7110
04*
* 17.0.0
* 17.00 fn
71'Q92
07-16-8;1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. ,
jthis6zSi 711 O = *
DATE ISSUED PERMIT NO. TOTAL
0
O
V
4.1
J
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