1983, 08-15 Permit: 83A-7804 Furnace[r'LAM IVIJMDCrt
�►rrLIgivik 1 KvAI/ rt nn 1 -611
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY S30et • s
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3.
2?
0.
ea fZ-, ..0t. �-' ° :-
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
_sem
CONT ACTOR,"
4.
TOR�� �� f� ` t
ADDRESS
DESIGNER
5.
ADDRESS
ZIP
LICENSE EXPIRES
PHONE
.� z�
Actual Set Backs in Feet to:
North 'South 1East I West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
99; G/
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No ❑ Req 'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
G eenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
WORK 0 BLD. 0 PLMB. ❑ MECH. 0 M.H. 0 POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8. DESCRIBE WQ@}(..--
VALUATION GAS/ ELECTRIC
9.
SOURCE
F
UTILLIITIES
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
Shorelines/Flood Hazard
Yes NotApplic. 0
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 state or local law regulating construction or the performance
of construction. SEE REVERS . • IDE FORREQUIREDINSPECTIONS
SIGNATURE OF �!% APPLICATION
OWNER OR AGEN '� �' � DATE 71
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
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
Plans Requ red ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEUISSUEJ 5- 8 3 PERM17 N&.O, 4 z
*1 4. 0 0 tqtAL