1980, 06-23 Permit G80-6188 2 BoilersAN NUMBER
•
ADDRESS V
IC�
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES SEE ATTACHED
L.EGAL DESCRIPTION
CONTRACT
4. ADDRESS
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
DESCRIBE WOR
VALUATION
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
PHONE
❑ MVE.
❑ POOL
❑ OTHER
PARCEL NUMBER/S
Required Set Backs in Feet
North South
Size of Parcel
Type Const.
Valuation
DWL Area
Split Entry
No. Baths
Occupancy
Basement Area
Zone Classification
DATE
Sprinklered
❑Yes DNo ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
9.application and have read the "NOTICE" provisions included
I hereby certify and
I know
read anand examined thisa
side, and know the same to be eras specified d hereinAor potVlThesg�anlaws
ting of a permit does not presumthis
e
on reverse oval law regulating action
provisions of any other
type of work willbe
olatelordcancel the p p
to give authority
performance of construction.
-V
DATE
11 DEPT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
Source
of
Utilities
SPECIAL APPROVALS
REQ'D.
state or
SIGNATURE_
SPECIAL CON
NS:
DATE — OFFICIAL
APPROVED FOR ISSUANCE
cons
3
or the
No. Rooms
Storage
Rancher
Rec. Room
Not Req'd.
FEES COLLECTED
Single ffi
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
i/1. .
•
618.62
0b-2 - 3 0
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS,BECgMES.A PERMIT.
(I6,72? 80 , 13,8. *26,J