1981, 10-15 Permit: 81B-702 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
JOB ADDRESS
1.,;
LOT BLOC!. SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
OWNERitC
I'
1 r�
PHONE
PARGt L•NUM' ER/S
ADDRESS
5—
CONTRACTOR,:,---
-
bNTRACTOR
ZIP
Actual Set Backs in Feet
North 'South East 'West
AD DR ES$
/(c, r, l
PHONE
ij2 /Jill
ZIP
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors l Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
X7/ /(
WATER
LECTRIC
Enum. Dist.
Location (Area)
SEWER
Ownership
Public ❑ Private ❑
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 SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
4G, 7)-a-37
/1
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
44'6* * 1 7.00
bel
*17.00
* 1 7.006
A *0,00
70.1
10-15-81
2 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
101-15-81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
70.22
PERMIT NO.
*17.0021
TOTAL