1983, 09-27 Permit: 83A-9560 FurnacePLAN NUMBER I APPLICATION/PERMIT
�JI 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- PARCEL NO.
1 & el
. i�6
2 LO ) I BLOCK SUBDIVISIONI LEGAL DESCRIPTION:
IQWNEP
HONE
(�
PHONE
'jA3 AILI G ADDRESS
Actual Set Backs in Feet to:
/,
Q
North South East
West
C NTRACTOR
LIC NSE EXPIRES
ONE
Size of Parcel
Zone Classification
Residential ❑
>�
Commercial ❑
4.
ADDRESS
Type Const.
Occupancy
Sprinklered
1
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
HADD S
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHAT 664 USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. El AD'N. El RPL. El MVE.
7. ❑OTHER
WORK El BLD. 11PLMB vIECH. 11M.H. 1:1POOL
Certifi.ofExempt.-T
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIB WORK /
8•�-
Shorelines/ Flood Hazard
Plans Required ❑
yes Not Applic. ❑
Received O
VALUATION
SOURCE
OF
AS
ELECTRIC
WATER
PUBLIC ❑
S WAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private ❑
1 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 wt�[i whetherspecified herein or not The granting of a permit does not presume to give au-
Building
I
thority to violate or cancthe provision f any other stat r local .law regulating construction or the performance
of construction. SEE RERSE SIDE OR AEOUIRED INS CTIONS
%,?
Plumbing
SIGNATURE OF APPLICATION
1
OWNER OR AGEN DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
/%l;l Q�—� S'
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Engineer
Utilities
r
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building V IQ/ IN 180 DAYS
Other (Specify)
`t 61
TOTAL $
PERMIT N MBER
Y
ti
0.4* * 1 8,00
* 1 8.006
A *0..00 0
95592
09-27-83
;2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED 2' t7 / PERMIT 4 5 6. 0 z.
* 18. 0 ffC�AL
CL
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W
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