1981, 05-20 Permit: 81A-4920 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.
3
4.
JOB ADDRESS
'LO BLOCK SUBDrVISIOIV
14/ D R v F l=
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
-S4Y INV j;:Srn�►£NT
ADDRESS
:3$1'30 1A5T L?0:)/V ="
PHONE
� 776
ZI P
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South tEast !West
CONTRACTOR
/v c, j-/ 2'j4 rJNG� C; o
ADDRESS
/ r 1'? /y i
DESIGNER
5. ADDRESS
PHONE
Size of Parcel ( Zone Classification
ZIP
y'y 2C
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
Dir NEW
❑ BLD.
❑ ALT.
E PLMB.
❑ AD'N.
ig MECH.
❑ RPL.
❑ M.H.
E MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE WORK
8 pj
VALUATION
9.
.7 . r R 14/ .--.1,4,4- '
GAS ELECTRIC
SOURCE
OF
UTILITIES
Enum. Dist.
ILocation (Area)
WATER
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 REVERSESIDEFOR REQUIRED INSPECTION
DATE OF APPLICATION /
/'' p / SIGNATURE OF APPLICANT
SPECIAL APPROVALS I SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui di�T chnici n , /
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
7
Mech. M
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ j 4- eo
PERMIT NUMBER
Iv+ - 2
04* * 1 4.00
* 14.00
* 14006
A *0,00
491.92
05120-81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
015-2a-8'1
DATE ISSUED
PERMIT O.�O Z *14000 TAL