1981, 09-21 Permit G81A-9611 Gas AppliancePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
6'A-,cam((
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
JOB ADDRESS
/'' '/'`
LOT
B OCK
SUBDIVISION
3.
OWNER
0 /711/ Zl f.1)- I / N(7-
ADDRESS
� � & / K --- 6 1'1*
CONTRACTOR
RolCCic/1'1 Hr7;�6c-.7�=c
4. ADDRESS
DESIGNER
5.
PHONE
foe
ZI,
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South (East (West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
DYes DNo ❑ Req'd.
PHONE
Valuation (Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors ( Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑{ADN.
IYI MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ OTHER
❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURC�J
OF
UTILITIES
vA464-
\2
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public 0 Private 0
Location (Area) FEES COLLECTED
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 INSPECTIOJS
,ATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
(e
l0s6/ Al,
/ /_ 0Priv
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
04* *18.00
* 1800
* 1 8.006
A *0.00
961.02
09-21-81 —
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
0 9j-'2 117811
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
9611zi; *18.00TIJ- -
PERMIT NO.
• TOTAL