1980, 02-05 Permit: 80-886 BurnerPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
2.
3
4.
JOB ADD ESS
0N -04.a Ay -
LOT OCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER...,�
ADDRESS
CONTRACr
SCL
ONE
Z4---xo 19
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North (South
East
'West
1441-11—A)
rel
zigflo78
Size of Parcel
Zone Classification
ADDRESS
SOOS
DESIGNER
5' ADDRESS
ZIP
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
bit
LSI ALT.
❑ NEW
❑ BLD.
DESCRIBE WORK
8.
VALUATION
9.
TO
Split Entry
Split Level
Rancher
E PLMB.
❑ AD'N. ❑ RPL. ❑ MVE.
MECH: 0 M.H. ❑ POOL
)kl‘sl-f7.
So urce
of
Utilities
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTI FICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
O6 iekts old �>l
WATER
GAS
1
ELECTRIC
SEWER
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 olocal law regulating constrylction or the
performance of construction.
DATE
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDI NS:
/U --o, 071 aTC.0
DATE OFFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
E
PERMIT NUMBER
&D 9
C f! *
* 1 2 0 0
1 L. '' 0 C
28,5
02-C 4' 80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 2.- 0.5 -18'0'
88.6` *12.00° -12