1980, 03-27 Permit: 80-2761 Fuel DamperPLAN NUMBER APPLICATION/ PERMIT 4_ PERMIT NU BER 1
SPOKANE COUNTY — BUILdlI t CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
*7.00
JOB ADDRESS
LEGAL DESCRIPTION -SEE ATTACHED * 7: 0 v
LOT BLOCK SUBDIVISION PARCEL NUMBER/S *7 O G y
2.
8• .f. l , / 57",,? r -c F QLt C /i 1>> tau S
VALUATION
Source GAS
ELECTRIC
WATER
SEWER
OWNER
of
PHONE
9,
�,
ali,-;L611 �
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
3. .���
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
ADD SS
,f:<
DATE SIGNATURE Me1ch. 3'e/e./
ZIP
Required Set Backs in Feet
r...f
t � U7tl 9 1; �7 �'
t�
�% it
`
North
South
East West
CONTRACTOR
Planning
PHONE
Size of Parcel
Fire Marshall
Zone Classification
Co. Engineer Other (Specify)
TOTAL $
Zone Clearance
4.
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist THIS BF,CONII, ,A f�RMIT.
ill
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
P /-'4 7%O ,,y-Vr 5 �
/c �.� f
C
IP9.2
I
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
DWL Area
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. ❑ MV E.
7, OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH: ❑ M. H. ❑ POOL CERTIFICATE Req'd. I Recd. Not Req'd.
of EXEMPTION
r,
276,0-R
03 -27 -SCJ
6479.
DESCRIBE WORK
FEES COLLECTED
8• .f. l , / 57",,? r -c F QLt C /i 1>> tau S
VALUATION
Source GAS
ELECTRIC
WATER
SEWER
of
9,
utilities
Single $
1 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 SIGNATURE Me1ch. 3'e/e./
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan heck
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer Other (Specify)
Utilities
C�
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist THIS BF,CONII, ,A f�RMIT.
ill
I DATE "1'-A / -Q( OFFICIAL 1
APPROVED FOR ISSUANCE
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