1983, 11-22 Permit: 83A-1950 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
1.
STREET ADDRESS
•-.l��zz
Cw.?t�z�c
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. A t2 -n-1(.
MAILING ADDRESS
S •
1 (.C62-
- C v .-2 t. Q. c
PHONE
PHONE
G1a-itlr- l�oQ
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North I South
il East Iest
CONTRACTOR
ML)fL-rbit�U� �� r
4-1Tce 4.7 e. lc.
LICENSE EXPIRES
PHONE
Size of Parcel
W
Zone Classification
Residential ❑
Commercial ❑
ADDRESS
IV . tLO--aiNG-,,C-e
ZIP
aaeL�
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remode ed 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 0 NEW 0 ALT. 0 AD' N. 0'R PL. ❑ MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. IL1 ECH. 0 M.H. 0 POOL ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8.
DESCRIBE WORK
a -At i cA - d LATT O L t_ Z o G w s
c.A. 20V IAC.
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE D
SEWAGE
SEPTIC ❑
SEWER ❑
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 o er state or local law regulating construction or the performance
of construction. SEE REV 3 SE SIDE FOR REOUI1_2_ INSPEa IONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
(9)
APPLICATION/ ,,g3DATE `
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
14' - t" ? tP1 Y3
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 $ 15:;- t7
PERMIT NUMBER
04*
194,92
11-22-83
64.7 9.
*18.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11 ;t j� r
DATEIS$JEb2 •2 8 3
PERMITiJv. •) 0 z
* 10.0 0.TDTAL