1980, 11-12 Permit: 80B-3554 FurnaceN 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 3 COPIES
JOB ADDRESS 1
LL �,° LEGAL DESCRIPTION — SEE ATTACHED
LOT I —BLOCK ISUBDI[VISION PARCEL NUMBER/S
2.
OWNER PHONE
3. 15 �I TL r� 26 —, ,t3
ADORr>-Q T %G /�G��� ZIP?Y-9 ! Actual Set Backs o Feet
IIII ff7�� OQ North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
4. ADDRESS
�� .CQ �� 7J {�!o,�„
ZIP
Type Const.
Occupancy
Sprinklered
[--]yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
s.
TYPEk/
❑ NEW ❑ALT. ❑ AD'N. JAI RPL. ❑ MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwelling
7, OF❑ OTHER
El BLD. ElPLMB. MECH. 1-1 M.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd
WORK
of EXEMPTION
I
SCRIBE WORKr �f
8 �%�G/9'G'� t5l1 LoeIg ���/ �✓� �t%
Enum. Dist.
Location (Area)
FEES COLLECTED
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
I UTILOITIES
Public []Private Cl
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
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
Building
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
Plumbing
9^6)
-�- 40
DATE OF APPLICATION // SIGNATURE OF APPLICA
Mech.
SPECIAL APPROVALS
NAME DATE
SPECIAL CONDITIONS: �
� G /3 �—u!
PERMIT IS NONTRANSFERABLE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ildin hnia�
Plan Check
SEPA
Mobile Home
PERMIT NUMBER
0
c
6.47
Other (Specify) -
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11:t}.2�$t 3,55,42 a .00a� -