1983, 11-29 Permit: 83B-2102 Furnace, PipingPLAN 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 + 7
1. � : i a3C)'j �66 /t%
LOT BLOCK SUBDIVISION
2.
PARCEL NO.
OWNER
3.
rjt c /V, st{;
MAILING ADDRESS f'7/‘71. M
PHONE
%7(
CONT CTOR
4. ` SS
ADD ESS yy�
y&L3C9
LICENSE EXPIRES
/)-�1
PHONE
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
11
Zone Classification
North South East West
Size of Parcel
ZIP'
Type Const.
Occupancy
Residential 0
Commercial ■
Sprinklered
❑Yes ❑No ❑ Req 'd.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF CI OTHER
WORK ❑ BLD. 1:11PLMB. 171MECH. 171M.H. CIPOOL
New Const. Valuation
Main Floor
Cover Deck
Remodeled Valuation
No. Baths
Upper Floors
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Garage/Storage
Fin. Basement
No. Fin. Rooms
Greenhouse
Unfin. Basement
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Non
Number
DESCRIBE WORK
SOURCE8.
OGAS
UTILIF
TIES \X,
VALUATION
9.
EL TRIC / WA R S WAG
E
PUB C ❑ S PTIC
PRIV TE ❑ SEWER 0
Shorelines/Flood Hazard Plans Required ❑
Yes NotApplic. 0 Received 0
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
PriELIM. FINAL DATE
APPLICATION
DATE /i7;7?9_1(3
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
fo
5- /02
11
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. Horne
Other (Specify)
TOTAL $ L?
PERMIT NUMBER
e
*18.00
*18006
A *0:00
=-10.1-2
11-29-83
6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEJIJE02 7 - 8 3
PERMITZ01 a 2 z
*18.00,,L