1981, 09-24 Permit G81A-9775 Gas Piping, BurnerPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
4.
5.
JOB ADDRESS! 3'7 )%•
G-431If (C(� R_ c.AD
LOT BLOCK SUBDIVISION
OWNER
ADDRESS
%"."111
CONTRACTOR
-C1,i-lr'Vr—rx'v
ay
Ibizz.Dr4a vL( 44N4
' it��`ac HTf 4)6.1.
ADDRESS
N , itCC�rL�c,=rZ
DESIGNER
PHONE
ZI P
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
PHONE Size of Parcel
ZI P
Type Const.
PHONE Valuation
Occupancy
East
'West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZI P
Main Floor f Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
OIL
6d NEW ❑ ALT.
❑ BLD. ❑ PLMB.
TO
❑ AD'N. ❑ RPL. ❑ MVE.
VMECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
Pv -Pt ? fs.Y.)
VALUATION
9.
SOURCE
OF
UTILITIES
TIES .2x...ki2,\;Et2.
GAS
ELECTRIC
WATER
SEWER
Area of Decks
No. Baths
Finished Basement
No. Stories
No. Rooms
Unfin. Basement
No. of Dwellings
f
CERTIFICATE
of EXEMPTION
Location (Area)
Enum. Dist.
Ownership
Public O Private LJ
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 INSP TIONS
C�' v` y ?) / f ta4
DATE OF APPLICATION f SIGNATURE OF APPLICAN �'�
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS: to 6 ,r 1q
FEES COLLECTED
Single $
Building
Plumbing
Mech. �v
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ I�r` •c'
04* *18.00
*1800
*18.008
A *0.00 0
977,4z
09-24-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8 'ding Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
9 4
4.
DATE SUED _ 8 1
977,55
*.18,00a--
PERMIT NO. TOTAL