1980, 01-08 Permit: 80A-9899 FurnacePLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
�V PERMIT V v� NUMBER
�
DATE
VALUATION Source GAS ELE7CTRIC WATER SEWER
of
9. utilities Single $
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 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 SIGNATURE— Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. C'1 Plan Check
Env. Health {\�J
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer It./VI 000 [ Tj �VI i�+ J Other (Specify)
Utilities u 1
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Q CST ,
DATE D' UV OFF[( -IA CL' CZ.N\JVA r(, -A q
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDR S
LEGAL DESCRIPTION — SEE ATTACHED
1
LOT
BL CK
D ISI
N
PARCEL NUMBER/S
2.
I
OWNER
PHONE
3.
ADDRESS
ZIP
Required Set Backs in Feet
North South
East West
CONTR T R
PHONE
Size of Parcel
Zone Classification
4'
AD R SS
ZIP
Type Const.
Occupancy
Sprinklered
fflry
T
❑Yes []No ❑ Req'd.
DESIG ER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE El
1:1 ALT.
❑ AD'N. ❑ RPL.
❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
El BLD.
1-1PLMB.
11MECH: ElM.H.
El POOL
POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
DESCRIBE WORK
8
FEES COLLECTED
�V PERMIT V v� NUMBER
�
DATE
VALUATION Source GAS ELE7CTRIC WATER SEWER
of
9. utilities Single $
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 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 SIGNATURE— Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. C'1 Plan Check
Env. Health {\�J
SEPA
Planning
Fire Marshall Mobile Home
Co. Engineer It./VI 000 [ Tj �VI i�+ J Other (Specify)
Utilities u 1
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Q CST ,
DATE D' UV OFF[( -IA CL' CZ.N\JVA r(, -A q