1980, 02-19 Permit: G80-1289 Gas BurnerPLAN 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 4 COPIES
JOB ADDRESS
LOT
,e 84) -____O 4--&-74/ pt3
BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3.
PHONE
PARCEL NUMBER/S
ADDRESS /'����'�
riCONTRACTOR
ADDR�
r>
DESIGNER
5. ADDRESS
IU . �:- T`I ✓ _ S
k& f1 E�
ZIP
Required Set Backs in Feet
North (South (East West
PW,ONE
&Y
Size of Parcel
Zone Classification
ZIjZ
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE E FROM
6. G//
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW [;"ALT.
❑ BLD. ❑ PLMB.
❑ AD N. ❑ RPL. ❑ MVE.
MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
600' LicrITT
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
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 • I. :I law regu)atyfig co truction or the
performayioe of /construction.
DATE
-I 1
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
14-1-
/O-0
DATE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
C2�'
711
PERMIT NUMBER
DATE C1 / / ?7
04* *1200
* 12.00 t
* 12006
E *0.00 8
127.7e
02-19-80
2 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOME§ A PERMIT.
0 2 --►1l9 1810
127.8
*12.002F>/
tri C ornTn❑