1981, 10-21 Permit: 81B-0942 Energy VentUMBER APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
/ NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUBDIVISION I PARCEL NUMBER/S
PERMIT NUMBER
DATE
OWN
3. ti
P ONE
� J4U-��
ADDR S
ZIP
Required Set Backs in Feet
North South
East West
CON
PHONE
Size of Parcel
Zone Classification
_�ACT0"
4. .4D ESS
ZIP
Type Co
Sprinklered
l�
�pancy
❑Yes ❑No ❑ Req'd.
DES GNER
PHONE
Valuation
Building Area in Sq. Ft.
5' ADDRESS
ZIP
OWL Area
Basement Area
Garage Ar;77
Storage
CHANGE OF USE FROM
TO
Split Entry
Split
Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE I�NEW ❑ ALT. ❑ AD -N. ❑ RPL.
❑ MVE.
7, OF %
1:1 BLD. ElPLMB. �MECH: ❑ M.H.
10 OTHER
❑ POOL
CERTIFICATE
Req'd.
Recd. iNot
Req'd.
WORK
of EXEMPTION
DES IBE WORK ,l
,
FEES COLL E CTED
8.
VALUATION Source GAS
ELECTRIC WATER SEWER
F)- L �'7� !� C� of
9, / Utilities �'J
Single $
1 hereby certify that 1 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
Plumbing
performance of construction.
A0 2 1. C�
l ,�
SIGNATURE )CW`L0- �a J�%�
DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
FOR GAS:
Env. Health
SEPA
Planning
PIPE SIZES:
Mobile Home
Fire Marshall
PIPE LENGTHS:
Co. Engineer
Other (Specify)
Utilities
BTU'S •
a
d
TOTAL $-/Z/_��
Zone Clearance
IN TH
WHEN MACHINE VALIDATED
Checklist
THIS BECOME% j P.�RMIT.
SEPA
r`�
�,� 81
DATE OFFICIAL c
APPROVED F R SUA E
,PACE,
9422 *14000QF