1984, 03-30 Permit: 84A-2779 Gas FurnacePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
.III•2 -1 At
LOT
2.
BLOCK
SUBDIVISION
OVEN ER
3. -;7' C 1'414 ni G
MAILING RE
Coot � oI 5 k
4.
ADDRESS aoYAA A412.W1A11 f-rr3 w A
DESIGNER
5. ADDRESS
PHONE
LICENSE EXPIRES
PHONE
ZIP ,
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
Size of Parcel
CHANGE OF USE FROM
ZIPG QQ
PHONE
ZIP
TO
TYPE 7LNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. ❑OTHER
WORK ❑ BLD. ❑ PLMB. $..MECH. ❑ M.H. 10 POOL
8. DESCRIBE WORK o K. ry,.st 6 (14\i
VALUATION
9.
SOURCE
UTILITIES
GAS'
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Type Const. Occupancy
New Const. Valuation
Main Floor
East
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
ElYes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage /Storage
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No
Received Yes No ❑I
Shorelines /Flood Hazard
Yes❑ NotApplic. ❑
Ownership
Public ❑ Private ❑
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 au-
thority 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
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
31)
APPLICATION
DATE
SPECIAL C DITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
CO
Other (Specify)
TOTAL
PERMJT NUMBER
5414 - 277°i
/1.* *20.00
*20006
A *000
277.82
03 -30 -84
2 61.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DAT i t1E, 0 - 8 4
PERMIT 737. 9 z
TOTAL
*2 a00a