1981, 01-15 Permit M81A-0503 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3676
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
4.
JOB ADDRESS
LOT
OWNE
11
BLOCK SUBDIVISION e &Rod t!f(�
ADDRE S
CONTR
/.6''0109 dee)d41)29-y
4TOR
ADD
DESIGNER
5' ADDRESS
P„tIONE
707 VS" Z119().3
I 1 i.;��9/�/
/ 2
PHONE10f.a72
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
East
'West
Zone Classification
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
DYes ❑No D 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
8.
9.
'A NEW ❑ ALT. ❑ AD N.
❑ BLD. ❑ PLMB. 'MECH.
DESCRIBE WORK
VALUATION
Si RCE
OF
UTILITIES
GAS
❑ RPL. ❑ MVE.
❑ M.H. ❑ POOL
ELECTRIC
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership
Public 0 Private 0
Location (Area)
USE CODE
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 /`-�'5 rp/ SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /44'
PERMIT NUMBER
04* *14.00
• * 1 4, 0 0
* 1 4.006
A *0.00 8
5022
01-15-81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
•
•
O .T , 11 5 0.'3 `Z
DATE ISSUED PERMIT NO.
*14'0.0a.
°°F
TOTAL