1983, 09-28 Permit: 83A-9617 Furnace, PipingPLAN NUMBER
APPLICATION/PERM IT
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. /D ee,
P
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNEROL�/ �
3.
MAILING ADD SS
PHONE
9a� 3—ti/77
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 'South
eOACTO@
4. iAAC- ,
AD RESS .4iaf
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
/a -a,(/
P ONE
9a6—/983
Size of Parcel
IIZone Classification
East
West
Residential ❑
Commercial ❑
ZIP
99c c
Type Const.
Occupancy
Spr'nklered
❑Yes 0 N Req 'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW 0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
7. OF
WORK 0 BLD. 0 PLMB. i4GIECH. ❑ M.H.
❑POOL ❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes No
Received Yes El No
Number
DESCRIBE yyffORK p
8. Jiuz ¢ ego owe) 47 -01 -Zoo �..G.,vn . 9-
VALUATION
9.
SOURCE 1 G
UTI LLIITI ES
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Plans Required ❑
Received ❑
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEW E
P 0
SE R
Ownership
Public 0 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 stateor local law regulating construction or the performance
of construction. SEE REVERSE SIDE F RE ED INSPECTIONS
SIGNATURE OF , /t APPLICATION C
OWNER OR AGENT `"1 ��Q-21V ,• gY2.r � DATE /() j?:5)
SPECIAL CONDITIONSSEE REVERSE SIDE FOR NOTICE)
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
//
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 $
yii
PERMIT NUMB
�
-�7
04* *1800
*18,00,5
A *000
961.62
09-28-83
X479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-;2.8
DATE ISSUED
PERMITS ,6 / Iz
*1 8. IJ 0.Pc.1L