1981, 11-19 Permit: 81B-1980 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
JOB ADDRESS
1.
LOT
2.
BLOCK
OWNER
SUBDIVISION
C_tATzt.7;
PHONE
C\7-C':�' 76&")
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ADDRESS
S : 14C57
4.
CONTRACTOR
Eit4YvG.�
T it -I 41J C\
ZIP
CAsCA .
PHONE
--7061
ADDRESS
� Lb4C S
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
121 NEW
❑ BLD.
ZI P
PHONE
ZIP
TO
❑ ALT. ❑ AD'N. ❑ RPL.
❑ PLMB. I (MECH. 0 M.H.
❑ MVE.
O POOL
0 OTHER
Actual Set Backs in Feet
North
South
Size of Parcel
Type Const.
Occupancy
Valuation
No. Baths
East (West
Zone Classification
Sprinklered
Oyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area l Storage
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Unf in. Basement
No. Rooms
Req'd.
DESCRIBE WORK
VALUATION SOURCE ELECTRIC
OF
9. UTILITIES
GAS
WATER
Enum. Dist.
Location (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 construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B din echnician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.=
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ C) -s, e -v
PERMIT NUMBER
04* *1200
* 1200 N
* 1 2.006
A *0.00
197.92
11-19-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'114-81'
DATE ISSUED
198.0
PERMIT N .
d
*12.00
-
a'F
TOTAL