1984, 01-13 Permit: 84A-352 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOK4ANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
LOT
2.
BLOCK
'ask), Edst 4e Fe
SUBDIVISION
PARCEL NO.
3.
4.
OWNER/1 (—Kern be r b.( ,esnsr
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
CONTd3CTt'• tic( Pd 4lZl�l C
ADDRE VV
. 30 Iv �SSiZ�L
ZIP
Actual Set Backs in Feet to:
North 'South (Fast I West
LICENSE EXP'PES
PHONE
Sas 7333
Size of Parcel I Zone Classification
Residential 0
Commercial 0
ZIP
g O at_
—
Type Const.
Occupancy
Sp nklered
CYes ONo ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled 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 gcuvEW 0 ALT. 0 AD' N. 0 RPL. 0 MVE.
i OF 0 WORK BLD. C PLMB. fl MECH. 0 M.H. 0 POOL OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi of Exempt.
or Variance
Required Yes❑ NoC
Received VesO No0
Number
8DESCRIBE WO\ Qns±, sxu) P2/ex/ uc7-
Shorelines/Flood Hazard
YesD Not Aeolic. 0
Plans Required 0
Received 0
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC'
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC C
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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 Iaw.regulating construction or the performance
of construction. SEE REVERSE SIDE FOR OUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION 1-1/—
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
110,44,
1/3
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)
Hoo
i
TOTAL $ / Q l)
PERMIT NUMBER
04A— 352
04* *14.00
*14.000
A *000 0
35.12
01-13-84
2 6479.
0.
O
V
W
—J
1.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
rj hitte+:'1.4. d
DATEL UED1`3I'18'4
11 �
Z 1
PERMIT Na 1/25, 2"Z
*14 0U U SYYAL