1982, 02-16 Permit: 82A-1020 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.
JOB ADDRESS
B
LOT BLOCK g U 7 (VISION ttlltR�tif ti
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3.
ADDRESS
CONTRA TOR ( /I
4.
PHONE
ZIP
PHONE
f5'.2./
Actual Set Backs in Feet
North (South [East (West
Size of Parcel 1 Zone Classification
ADDR
DESIGNER
5' ADDRESS
ZIP
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation 1 Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin_ Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
O PLMB.
❑ AD'N.
O MECH.
❑ RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE WORK ��
8. ":" /7, 71 lac � c
VALUATION ELECTRIC WATER
CCP
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
ILocation (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 constructior the
Apormance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION P 4d ' �' SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
[ties
Plans Examiner
SEPA Checklist
Building Technician
•
SPECIAL CONDITIONS: •�A
--ESTL.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
t (o
TOTAL $
PERMIT NUMBER
0.3." - ib ,
J4* *1600
* 1600
* 1600e
A *0.00 F3
101.92
02-16-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
V2!..-4 6-'8(2 1'0202 *16.00a
�
DATE ISSUED PERMIT NO. TOTAL