1980, 04-14 Permit: 80-3479 Gas BurnerPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRES•4HARD TO MAKE 4 COPIES
2.
3.
JOB ADDRESS
LOT
BLOCK' SUBDfVISION
ADDRESS
N E
Z I Pq ? 3
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North South 1East (West
CONTRACTOR
1(4-
40
4.
ADDRESSC1 Q �
X'
a �,t�,��
DESIGNER
5' ADDRESS
PHONE
Size of Parcel 1 Zone Classification
Z7
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6. 1
❑ NEW ALT.
❑ BLD. ❑ PLMB.
TYPE
7. OF
WORK
8.
9.
DESCRIBE WORK
VALUATION
TO
Split Entry
Split Level
Rancher
❑ AD N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Source
of
Utilities
GAS
ELE TRIC
No. Baths
No. Floors
No. Rooms
Rec. Room
l/V61L'/ 1
WATER
CERTIFICATE
of EXEMPTION
SEWER
Req'd.
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
performan of co truction. D
DATE `�Z/ Po SIGNATURE i Ifn�re�PLC/LL'2L
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
$o AN Gu._ C�,„n►; L�,
r f& 'i
DATE
OFFICIALPZ _ /
APPIPOVF11 CIIANCF
Recd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. 7_, 00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ oU
PERMIT NUMBER
So -3979
D AT E J U1 At.l<t
* 12.00
* 120
* 1200
E *000
3U._7.8
04-14-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PE,RMIT.
04!-i14-80 347.95
*12.00°-'