1981, 08-26 Permit: 81A-8570 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
LOT
E R Sit;
BLOdK
LEGAL DESCRIPTION — SEE ATTACHED
• •
UBDIVISI
0
PARCEL-NUMBER/S
OWNER
DO Dov C. Ptziw
ADDRESS
PHONE
E . 831C„ 1JO2-14
ZIP
9.q cr•
Actual Set Backs in Feet I
North 'South East . 'west
4.
CONTRACTOR
cSvtYVtE,
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
x aME
ZIP
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑.Req'd.
5.
DESIGNER
PHONE
Valuation 1 Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unf in., Basement
fLl NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. I!7 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
DESCRIBE WORK
8. I cOI UCO STs. Gos riAaNACC
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
I hereby certify that 1 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 APPLICATIONX '— a — -. SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Build • Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single • $
Building
Plumbing
Mech. . ‘c.). GG
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ tto: Cr+
PERMIT NUMBER
- 70
04* *1600
*1600
*16006
A *000
85692
0.8=26-81
2 6479
ei
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ti
81547'4'0
DATE ISSUED .6 PERMIT Nz }
0.