1981, 09-04 Permit G81A-8927 Fuel DamperPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
I — 692-7
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
F./o `)/� -
LOT[BLOCK SUBDIVISION
2.
3 OWNER
1.
4.
ADORES
CONT,
A D DR([_l
ACTOR
CcIAA_A- p EAT-
s5 t~ LC
(')7/C �_ (J D/AAJA
DESIGNER
5, ADDRESS
PHONE.
ZIP
t 1)
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
PHONE
Ok-,?/C6
ZIP
c,) ( 1 a%
PHONE
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
Valuation
Occupancy
East
!West
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6,
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. ❑ AD'N. 0 RPL. 0 MVE,
❑ PLMB. Q,MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
Enum. Dist.
Location (Area)
VALUATION
SOURCE
OF
UTILITIES
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
9.
I hereby certify that I have red 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
q g f
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
(< ay" (A_
51t,lit/ieA
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
1q,6r
TOTAL $ /� Ot}
04* * 1 4.00
* 1 4.00 }
* 1 4,006
A *0.00
8926
09--04-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
• 1- 8'`i( 8 9 i2 7 z *1 4:0 '0
io; +,
DATE ISSUED PERMIT' NO. TOTAL
t4