1980, 10-14 Permit G80B-1939 Oil to GasAPPLICATION/PERMIT
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
LO BLOCK SUBD ISION
p,\.„
3
OWNER
ADDRESS
CONTQR 4TOR ,
ka
4' ADDRESSDA �!
DESIGNER
PHONE
9e24-
ZIP
PHONE
ZIP
PHONE
ADDRESS
6. CHANGE $F U
TYPE
7. OF
WORK
FROM
ZIP
TO
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North South
East
West
Size of Parcel
Zone Classification
Type Const.
Valuation
Main Floor
Occupancy
Upper Floors
Area of Decks
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
❑ NEW ❑ ALT. 0 AD'N. ❑ F PL ❑ MVE.
BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
❑ OTHER
SEWER
No. Baths I No. Stories I No- Rooms INo. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
Req'd. Rec d. Not Req'd.
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 /0 " /
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
6
d `
FEES COLLECTED
Single
Building
Plumbing
Mech- !2
Plan Check
SEPA
Mobile Home -
Other (Specify)
$
TOTAL $
/_zs
P MITyNUMBER
+ g 173
04* *1200
*1200
*12.006
A *0,00
193.82
10-14-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ding
cian
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
. 0 ',1141' 8 J'
DATE ISSUED
1939z *12,00P. -
PERMIT NO. TOTAL