1980, 12-01 Permit G80B-4318 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (609) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. l r ti 6 G�
LOT BLOCK SUBDIVISION
s)WNER PHONE
3 V eLy InO 0( W; \i/1"j) 7n Lt. 1—y-I -33V
ADD ESS Z P
aq, '. �we-rw� eyes rr wn- 43 e• o�
CONTRACTOR / P�H'NE
4. At D Y" L-d 1 - P ct, f t 71, C ,'A m` f.1%�`9%✓-
AD RESS ZI�
c'.�"/ 7_ - '-z 4 9za
DESIGNER PHONE
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
ZIP
TO
❑ fp N. RPL. ❑ MVE.
W MECH. 0 M.H. 0 POOL
0 OTHER
LEGAL DESCRIPTION - SEE ATTACHED
.ARCEL iJUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
Occupancy
East
West
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Valuation Building Area In Sq. Ft.
Main Floor
Upper Floors
Area of Decks
No. Baths
Garage Area
Finished Basement
Storage
Unfin. Basement
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
DESCRJBE WORK
Enum. Dist.
Location (Area)
9.
VALUATION SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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 regul ting construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED I PE:' IONS 6.+.1. / LIG
DATE OF APPLICATION /' l/e, SIGNATURE OF APPLIC
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building
lc an
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$1,2�
04* * 1 2.00
* 1200
* 1 2.0n
A *0.00
431,7.-G
1 2-01 -80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1;1 2170';}'1:.� +810 4';3 `L 8 .z * 12 0,0 ° ' -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
DATE ISSUED
PERMIT NO. TOTAL