1981, 01-08 Permit: 81A-0200 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 4 COPIES
1.
2.
3
JOB ADDRESS
LOT
't` 11 L .1
BLOCK 1SUB IVISION
LEGAL DiSCRIPTION - SEE ATTACHED
OWNER
ADDRESS
(KV Lj 1 r\ n'1'k'T
cX W\
P126 3bae
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North (South
East
'West
CONTRACTOR 1
4. �} �7c'1 �.1)Q J V\ \\ji nc-t
ADDRE S
PHONE
3�1_AI
Size of Parcel
Zone Classification
ZIP two, 1
Type Const.
Occupancy
Sprinklered
Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
ZI P
Building Area in Sq. Ft.
DWL Area I Basement Area r Garage Area I Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
E ALT. El AAD'N. ❑ RPL. ❑ MVE.
❑ PLMB. L"J 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
i-
8..— .n3k-( \ o.cs t,.c flack --
VALUATION Source
of
9. Utilities
1:1Q ,COu
ELECTRIC
GAS
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 or local law regulating construction or the
performance of construction.
DATESIGNATURE (1).A(-CY CI
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
7,56
I7°°°
DATE � OFF IAL
APPt ��� ''W`FUK ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. 17
Plan Check
SEPA
Mobile Home
Other (Specify)
po
TOTAL $ 17 °°
PERMIT NUMBER
DATE
04* *17,00
* 1 7.00 U,
*17,006
A *000
19,98
01'=08-8 1
z 6479.
WHEN MACHINE VALIDAT. D IN TI -HS SPACE _
THIS 11OMBI6IT 2 O
a
Z
4
*17.0 0
a�