1980, 06-11 Permit: 80-5597 FurnacePLAN NUMBER
At
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
`f
JOB ADDRESS
t LOT/I BLOCII SUBDI V IS:1
.CL144.t
2.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
VNER
ClAti,XS 9./.t. ./Oi
�Ab DRESS -'teqr /' �,„�,�,�,��'y�7� /1
C( JTR14 ACTO VL`�/ r I F
4. E
ADDR$S
ESS
SX J,t�rL1 Fi
PHONE
ZIP
Actual Set Backs in Feet
North (South
East
'West
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
•
Sprinklered-
Oyes DNo 0 Req'd:
DESIGNER
• 5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks ,
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK '0 BLD.
O ALT.
O PLMB.
❑ AD N.
O MECH.
❑ RPL.
O M.H.
O MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
9.
ESCRIBE QRK( A
AAL4244 jit-/-144141-
SOURCE GAS
OF
UTILITIES
1-4
VALUATION
ELECTRIC
WATER
Enum. Dist.
Location (Area)
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
GATE OF APPLICATION �+ — / -R-0 SIGNATURE OF APPLICANT
SPECIAI, APPROVALS
NAME DATE
Env. Health
Planning '
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
EPA Checklist
Buui,IdingTec nlcia �..-
.f(414' r Q zzt 4i
SPECIAL CONDITIONS:
XL4A-412"41u ,l-' tcadti. e .6 -// - +?
S
13/,.t,c,k, "Lat.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
. Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
417 jo__D-
761)
.r
TOTAL
M
rE R MI T•N U MB ER
go ssg 7
04*
*7.00
*7.00 n
559.62
06=11-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
b,'6,SIJ]P ;,8r0
DATE ISSUED' `'
PERMI15 D.9, 7
* U uTALI
F
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