1981, 07-13 Permit 81A-6922 Replace BoilerPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
ibt
PERMIT NUMBER
S/A /g22
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
'd / P9-ze- /4%d-
OT
B OCK
J'J UIVIJI,JIV
3 � '— ,42 Ae/4_5g
ADDRESS
CONTRACTOR
4 �r$Je y—&/'it/,,9 Gem'
Yi/ Lew Pa fie3Ki/ya
5. ADDRESS
DESIGNER
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const. 1 Occupancy
Valuation
East 'West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
0 BLo.
❑ ALT.
❑ PLMB.
❑ AD'N. L RPL.
1ECH. ❑ M.H.
DLESCRIBE WORK/� %%
8. 1�0%l' 4-642 ' 4J/ 50/L gi ei e/;/
VALUATION SOURCE GAS ELECTRIC
OF
9. UTILITIES
❑ MVE.
❑ POOL
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Location (Area)
Ownership
Public ❑ Private 0
USE CODE
Req'd. 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
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ //71�
04* *17,00
* 1 7, 0 0 1
* 1 7.006
A *0,00
692,'1
07-13-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
lQ 7(_1.1:3' 8011
DATE ISSUED .
PERM TI 7N ? z * 1 r' O' TuiRIL