1982, 11-12 Permit: 82B-0876 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
JOB ADDRESS// �'
/2 9// /5e ;2'.5
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
PHONE
1 44--4"5'
PARCEL NUMBER/S
ADDRESS
ZIP
Actual Set Backs in Feet
North 'South
East
'West
CONTRACTOR
4. /3ADp 6 //�.� 1:71-4 'A7�C'e Fri '-� .z
/I/6. 61 646
PHONE
S2%/r
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
Eves ❑No 0 Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
0 BLD.
0 ALT.
❑ PLMB.
❑ AD N. .6,1 RPL. 0 MVE.
IMECH. ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
Enum. Dist. I Location (Area)
DESCRIBE WORK
8. PO 7754-4 !,- 45A/A/6,i-' 7/4JE--- i -'7I % �i.�'i✓,
VALUATIONSOURCE SEWER
OF
9. UTILITIES
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 J
DATE OF APPLICATION 1/ - S — °"2" ---SIGNATURE OF APPLICAN)7;��:d."-CCW7
SPECIAL APPROVALS
NAME DATE
GAS
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ilding Technician
ELECTRIC
SPECIAL CONDITIONS:
WATER
Ownership
Public 0 Private 0
s
" /,e 1A /<,
PERMIT IS NONTRANSFERABLE
USE CODE
//%�i7,1-/.sr
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing —
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $' UQ
PERMIT NUMBER
04* *22.00
*22008
A *000
87.5
1 1 -1 2-82
� 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'1 712-82
8 7,6z
DATE ISSUED PERMIT NO.
*2210
0 Al-