1980, 02-11 Permit: 80-1046 Furnace Pi.AN NUMBER y _ APPLICATION/PERMIT 4 M PERMIT UM NUMBER i
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
0Li * * 7.00
JOB ADDRESS 76 LEGAL DESCRIPTION — SEE ATTACHED * 7. 0 0
1. E /.3 ': y /02,
LOT BLOCK SUBDIVISION PARCEL NUMBER/S * 7 n n �.
2. J l'
OWNER PHONEki,Q�L'K. E ;, C V,0 C,', c:
J
3. Doc z ce %/c:t`!"-41 ec..t..- y'' - 4.,/ 1 0 4,5 p
ADDRESS / 77/ ZIP Required Set Backs in Feet
, /3 7.2 y /rA / Ve,�r.ee vu�p , 4J V 7O3 .) North 'South East (West 0 G- 1 1 -8 0
CONTRACTOR PHONE Size of Parcel Zone Classification
4. '4 ii`"/lid,.:.1 i y Al e a er.-� Yd r/'c i-4/c /A/c �Jvt i---,2/4-'0 2 6 Q 7 9,
ADDRESS / / / zip Type Const. Occupancy Sprinklered
E."1:02- /.
9/V y/G.-et.• j ..5e;ieoe_o✓G/ i.s/tC 5 ,'.2-/C, ❑Yes ❑No ❑ Req'd.
DESIGNER �/ PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I Basement Area Garage Area Storage —
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No.Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF 0 OTHER tReq'd. Rec'd. Not Req'd.
WORK ElBLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8. /4-5 Tu/ i.)....2. S—.e4�.," ,7---1,.e A..,vrX e e L-,,TA 91.., A....,-.r,C FEES COLLECTED r
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
Single $
—
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 Building
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. Plumbing -
DATE rpt " �— V'el SIGNATURE --- -Is i.--ty-2---7-`—e—`-' 3,c=C,Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: '.- at cY i/42 e?
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA `--
Planning _
n
Mobile Home n
Fire Marshall
Co. Engineer Other(Specify)
Utilities
TOTAL $ /.C C2
Zone Clearance
fi WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist t THIS BECOMES A PERMIT.
�:1t at
DATE OFFICIAL J - �� -U r /�, 1 .
APPROVED FOR ISSUANCE
—