1981, 05-20 Permit G81A-4918 Convert Coal FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
6(n- ckcite
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRE,SS HARD TO MAKE 3 COPIES
JOB ADDRESS
•Zi
3.
LOT B OCK
OWNER
ADDRESS
U1=fu1 V IJI IJIV
CONTRACTOR
4, ADDRESS
DESIGNER
5' ADDRESS
PHONE __
ZIP
PALCJN ► 40
PHONE
CHANGE cIDU^ USE FROM TO
6. W AL_
TYPE
7. OF
WORK
ZIP
❑ NEW Tt ALT. ,❑, ADDN. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. LLSMECH. ❑ M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North South
East
West
Size of Parcel
Type Const. Occupancy
Valuation
Zone Classification
Sprinklered
Des No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor Upper Floors
Garage Area
Storage
Area of Decks
No. Baths
Finished Basement Unfin. Basement
No. Stories 1 No. Rooms INo. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
9.
D -CRIBE WOR
k
ALUATIIQN
01-3
es
SOURCE
OF
UTILITIES
ELECTRIC
it
I-e
WATER
SEWER
Enum, Dist, Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
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 INSPECTIO
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
r
/0400o TU. eoNvevsi bu(
f , C21-s Rie
/5t
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
$
Mech. * j• V�
Plan Check
SEPA
y4.4"
Mobile Home
Other (Specify)
TOTAL $ IU•Ve
04* *18,00
* 18.00 '6
* 1 8.00U
A *0,00
491,72
05-20-8,1
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
9 /,01.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
,0 �i_,121,a,! 8;1
DATE ISSUED
4918Z
PERMIT NO.
*T8,00a1.--1_
TOTAL