1980, 11-17 Permit G80B-3785 Gas HtrPLAN NUMBi=R
APPLICATION/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
J
JOB ADDRESS �� }
0-2- is rq
LOT BLOCK SUBDIVISION
OWNER N
3 tM�
ADDRESS
h-T 1 rOC
4- ADDRESS
CONTRCT
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TO
PH NE
19t3
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/5
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const. Occupancy
!East (West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
TYPE
7. OF
WORK
Ec NEW ❑ ALT. D A 'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. Ild"MECH. ❑ M.H. ❑ POOL
DESCRIBE W K I i (i
8. VALUATION SOURCE GAS ELECTRIC WATER'
❑ OTHER
Main Floor Upper Floors Garage Area
Area of Decks
No. Baths
Storage
Finished Basement Unfin. Basement
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
OF
9. UTILITIES
rf
SEWER
Enum, Dist, I Location (Area)
Ownership
Public ❑ Private 0
USE CODE
I hereby cerify 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 t
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS /
DATE OF APPLICATION ` / �v SIGNATURE OF APPLICAN 1
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
(ding Te
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *22.00
*2200 rri
*2200,
A *G00 9
37842
11-17-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.1.t1H80 378.5z, *2.2002g-
DATE ISSUED
PERMIT NO. TOTAL