1980, 02-27 Permit: 80-1556 FurnacePLAN 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 LEGAL DESCRIPTION — SEE ATTACHED
1. z4 -/
LOT I BLOCK IbUBDIVISION I PARCEL NUMBER/S
OWNER
3. P✓1
ADDRESS
CONTRACTOR
4.
4' ADDRESS
ee /rR rVe"
DESIGNER
�' ADDRESS
1
f ie /`G i�®G/FcLytai li
'v S!1 � /� iYJ✓ P �%G1
PHONE
ZIP
PHONE
ZIP `
PHONE
ZIP
CHANGE OF USE FROM
6.
TO
North South
East West
TYPE El NEW
El ALT. El AWN.
❑ RPL.
❑ MVE.
7
-1PLMB.
Sprinklered
❑ OTHER
WORK 1:1 BLD.
1:1MECH:
ElM.H.
El
DESCRIBE WORK
8. ('M G !Jf v
�ofri
DWL Area
Basement Area
Required Set Backs in Feet
North South
East West
Size of Parcel
Zone Classification
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
Type Const.
Occupancy
Sprinklered
I
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
DATE v'Z � SIGNATURE .�
v
Mech.
DWL Area
Basement Area
Garage Area
Storage
DEPT. REQ'D. RECD.
Plan Check
Env. Health
Split Entry
Split Level
Rancher
Planning
Mobile Home
No. Baths
No. Floors
No. Rooms
Rec. Room
Utilities
TOTAL $
Zone Clearance
CERTIFICATE
Req'd.
Recd.
Not Re(
of EXEMPTION
L - L
FEES COLLECTED
"vLsG..y.rr r'.
PERMIT NUMBER
t1\ I
DATE
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
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 v'Z � SIGNATURE .�
v
Mech.
`K �G
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
DAT FA a^IAj0bFFICIAL Q.5aA A miU
L - L