1980, 09-22 Permit: G80B-631 Fuel DamperPLAN 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.
JOB ADDRESS
/0 '%3+"
LOT
BLOCK
' O
LEGAL DE43CRIPTION — SEE ATTACHED
SUBDIVISION
OWNER
!p2.2NE
PARCEL NUMBER/S
ADDRESS
ACTOR
ZIP
Actual Set Backs in Feet
North 'South
East
West
CONT
�`.�
4' ApOREss
- 77//e)
R// )
PHONE
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No El Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
AD'N. ❑ RPL. ❑ MVE.
�,/
'tL'J MECH. ❑ M.H. ❑ POOL
El OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. Lica.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
Iii Q?' L- yV
ELECTRIC WR
I
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 constructio or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION '1
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu ding Te nicia/ry
Zoalv
SIGNATURE OF APPLICA
ECIAL 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)
4 (-)
TOTAL $/
PERMIT NUMBER
Foe- .;' /
*7.00
*7,00
*7,006
A *0,00
63.02
09-22-80
2 64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
092'2'`8:`0
DATE ISSUED
6312 *7.00°�
PERMIT NO. TOTAL