1984, 04-05 Permit: 84A-3023 Gas 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
1. 5••
LOT
2.
BLOCK
OWNER
Z.
SUBDIVISION
t17 1, v r
MAILING ADDRESS
,�
4.
CONTRACTOR
ADDRESS
PHONE
LICENSE EXPIRES
PHONE
-C-13•7)
5.
ADDRESS
DESIGNER
CHANGE OF USE FROM
PARCEL NO.
LEGAL DESCRIPTION:
ZIP Actual Set Backs in Feet to:
'.� North (South
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. LE'AD' N. ❑ RPL. E MVE.
7. OF WORK ❑ BLD. ❑ PLMB. Li/MECH.❑ M.H. ❑ POOL ❑ OTHER
East
Size of Parcel
Type Const. Occupancy
New Const. Valuation
Main Floor
Cover Deck
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
❑Yes LI No ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck
No. Floors
DESCRIBE WORK
C4344 -r-?— —fi 1�
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes ❑ No❑
Received Yes❑ No❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Private 0
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 APPLICATION
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Heald
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (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 Requ'red ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
P —�
)4* *2000
*20.006
A *0.00
3022-2
04-05-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
TATE ISSUED O 5— v 4 PERMIT 400 2. 3 2 * 2 0. 0 01#4L