1981, 11-12 Permit 81B-1759 FurnacePLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDMG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. ti r�i i✓�'�
LOT BLOCK SUBDIVISION
3.
OWNER N/�11
4i
ADr E ,J 71 7) r<b
COI�VzTRACTOR �� �.
4. A
6.
D RESS
DESIGNER
PHONE
ZI P
PH
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
East
West
Size of Parcel Zone Classification
•
PHONE
Type Const.
Occupancy Sprinklered
EYes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
ADDRESS
CHANGE OF USE FROM
TYPE
7. OF
WORK
ZIP
TO
NEW ❑ ALT. ❑ A 'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. IFIE/MECH. ❑ M.H. 0 POOL
DESCR,I
E WORK U
(� toj
WATER
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
❑ OTHER
Main Floor Upper Floors Garage Area Storage
No. Baths No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
Not Req'd.
Enum. Dist. I 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 _ regu •ting cs str ion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECT'
DATE OF APPLICATION // tV° / SIGNATURE OF APPLICA
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ I
04*
* 1800
* 1800
175,82
11-12-81
2. 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building ram.
it
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
1 L.12Zi`- 81
DATE ISSUED
17.5'9 5
PERMIT NO.
*18.0021-2 -
TOTAL