1980, 10-09 Permit: 80B-1717 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 3•COPIES
1.
2.
3.
JOB ADDRESS
C, ?( 70
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
Xi,eoc.O .0711e> CC.;
ADDRESS
C. 9 707 /71/5sso�v
CONTRACTOR
4. ✓ f
ADDRESS
Ctrs Tc iyc
DESIGNER -
5.
PHONE
9Ly-37,30
ZIP
4-'S))
z
Actual Set Backs In Feet I '
North 'South East 'West
PHONE
63Y -93c'/
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
DYes ONo 0 Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
IS NEW
0 BLD.
O ALT. 0� AD N. 0 RPL. 0 MVE.
L7/
O 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:
DESCRIBE WORK
8. /25-., o00 7374 /2.YcC.M
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
ELECTRIC
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
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building
nIc an
✓ �n
l
SPECIAL CONDITIONS:
Qa
c To
CbbAd r4» c7o2
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.• �/ �/y{
g 00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /1.00
PERMIT NUMBER
Sar3•17/7
04* *11.00
* 1 1.0.0
* 11.00
A *000 8-
1.71.62
10-09'-80
2 -6.479. -
4,
4,
•
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11�: 4t�8''Ol 1`7171 *1LO0a�
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE - DATE ISSUED PERMIT NO. TOTAL
>-
0_ o_
0
0
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