1981, 05-20 Permit: 81A-4922 FurnacePLAN NUMBER APPLICATION/ PERMIT PERMIT PftiMBER..
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1.42
LEGAL DESCRIPTION - SEE ATTACHED
LOT BLUCK IbUBUIVISION PARCEL NUMBER/S
OWNER
Actual Set Backs in Feet
North South East West
1A
Size of Parcel
3. 4
ZIP
ti
ADDRESS !t
L7 _
CONTRACTOR
HONE
4. A I /) � I Z
TJ o l'
ADDRESS
Main Floor
5' .0
S -J k
DESIGNER
' ADDRESS
0",/Y L.:
CHANGE OF USE FROM TO
6.
PHONE
ZIP
Actual Set Backs in Feet
North South East West
PHONE
v
Size of Parcel
Zone Classification
ZIP
ti
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
HONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
G=
Storage
Area of Decks
Finished
Basement I Unfin.
Baseme
TYPENo.
NEW ❑ALT. ❑ AWN.❑ RPL. ❑ MVE.
Baths
No. Stories
No. Rooms
No. of Dwellings
7, OF ❑
CERTIFICATE
Req'd.
Rec'd.
Not Req'd.
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
of EXEMPTION
ESCRIBE WORK
dOwnershi
Enum. Dist. Location (Area) FEES COLLECTED
8. A� S f
USE CODE
V LUATION
SOURCE
GAS ELECTRIC
WATER
Sp
9.
UTILOITIES
X
Public El Private ❑
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
type of work will be complied with whether specified herein or not. The granting of a permit does not presume Building
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
Plumbing
�
DATE OF APPLICATION— SIGNATURE OF APPLICANT �� �
Mech. -��—
SPECIAL APPROVALS SPECIAL CONDITIONS:
J
NAME DATE
Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)—
4
Utilities
TOTAL $ cdv
Plans Examiner
04* * 1 4,00
*1�00 u
*14,00
A *0.00
492.1
05-20-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Buil ng T hnician PERMIT IS NONTRANSFERABLE O �I ;�� a �.8"1 i} 9 �, 2 Z 1,� O O (LF –
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE'IS5UED PERMIT NO. TOTAL
r, c