1984, 02-09 Permit: 84A-1125 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
1. 53) 0 .v
LOT
2.
BLOCK
SUBDIVISION
OWNER /�'^
3.MAILING ADDRESS
el al
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North ISouth 1East I West
4.
CONTRACTnR
ADDRESS x4/5 -
/L — /0 '2-- A(17 Q
LICENSE EXPIRES
PHONE
yf3�
ZIP
67 C
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
Type Const.
Occupancy
Spr nklered
ores ONo ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE "NEW ❑ ALT. 0 AD' N. ❑ RPL. ❑ MVE.
7. OF B WORK BLD. 0 PLMB. %MECH. ❑ M.H. 0 POOL OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certlf 1. of Exempt.
or Variance
Required Yes No❑
Received Yes No❑
Number
8.
DESCRIBE WORK
- ett lw.„ 9 _ w,1
Shorelines/Flood Hazard
Yes❑ Not Apollc.❑
Plans Requ'red 0
Received 0
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
LLECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 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 locallaw regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
r/ In.u1�
SIGNATURE OF 1mil
OWNER OR AGENT 4-
ssisum¢ •
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Hea^;h
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Zl9
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
q v� �v r iii y sl
! t( �. �v...! ) �'
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
$ V
P RMI NUMBER
112.
04* *23.00
*23.006
A *000 8
112.48
02-09-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n aa•l�t' 1 ... G
DATEkUUEO' 9 —. 8:4 PERMIWjjI
L.Cq • / z' * 2 5 0 O'aOTAL