1983, 09-21 Permit: 83A-9318 FurnacePLAN NUMBER APPL ICAT ION /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 PARCEL NO.
1 M 3 Z G tZa t' a�
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER
PHONE
I
PHONE
3. n`/ yhwN
-�
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
< *3;-2_-) [7
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4. `3
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
C r 4
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6. 8ity
Cti��
TYPE El
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW ALT. El AD'N. RPL. El MVE.
7. OFElOTHER
WORK ❑ BLD. ❑ PLMB. fl MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt. Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK _
8• R0, C:)=�0 e'>'T— 6,IA--._KkQN g
Shorelines/ Flood Hazard
Plans Required ❑
Pc.E < < p C'
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9.
I SOOUFCE
GAS
ELECTRIC
PUBLICO
SEPTIC O
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public El 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-
Building
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
Plumbing
SIGNATURE OF,( APPLICATION
OWNER OR AGENV ` t -- DATE r, .2 / " &'3
Mach.
SPECIAL APPROVJ
PRELIM. FINAL
Env. Health
Planning
tngmeer
Utilities
Plans
Exam.
Building
Tech. 1
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE'1SSUE� .1 — PERMITS �. 1i " z * 1 8' O O COITAL
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