1981, 09-11 Permit G81A-9245 Gas Hook Up(PLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — bUILLING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1.
LEGAL DESCRIPTION - SEE ATTACHED
LOT LO K SUBDIVISION
2.
OWNER
3. T f'r tit) / N., ,C3
ADDRESS
•1\c-1'Lb Aft fVSPIE4-0
CONTRACTOR
4" ADDRESS
S•�
DESIGNER
5' ADDRESS
PHONE
ZIP
Ci42--OC;
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
Size of Parcel
East 'West
Zone Classification
ZIP
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
I NEW ❑ ALT. 2.."-MECH.
❑ RPL_ ❑ MVE.
❑ BLD. [1] PLMB. (Jd MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. MfaP,b i t. E; •1C
VALUATION
9.
SOURCE
OF
UTILITIES
l�ICO�-t-LP CCU► .
GAS
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B ild Technici
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech. I .2 '
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
I- HMI I INUMb l(
*12.00
*1200 t
921L42
09-11-81
2 6,479.
•
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,O 9l�11.,1:-81'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT IS NONTRANSFERABLE
9245z *12002.
PERMIT NO. TOTAL