1981, 02-09 Permit: 81A-1279 FurnacePLAN •rQUMBE-R-
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
sir
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
JOB ADD; 7 d rit
�f/ 3 O Lr%+e .��
LOT SUBDIVISION
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
ADDRESS
PHONE
ZIP
Actual Set Backs in Feet
North (South
CONTRACTOR
RAC
;fit €,
4. ADDRESS
DESIGNER
PHONE
East
West
Size of Parcel Zone Classification
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd_
Valuation
Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
6.
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Storage
Unfin. Basement
TYPE
7. OF
WORK
,..Ver NEW ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N. ❑ RPL. ❑ MVE.
X-MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE npRK/ L�
S. �,,•�s" /.4 l it �/ GC417/G
VALUATION
9.
SOURCE- GAS
OF
UTILITIES
ELECTRIC
WATER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Recd.
Not Req'd.
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 construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION,Z -T---,/
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
mg g T+�V''
SIGNATURE OF APPLICANT ��6 •iLJ2 fG�
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
.GSC
TOTAL $
1,
M
j..
PERMIT NUMBER
-
04* *14.00
*14,00
*14.006
A *0.00 g
127.82
02-09-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02x=09-81 127:92 *140.020
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL