1983, 08-30 Permit: 83A-8368 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMEI&T OF BUILDING & SAFETY 6
19
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 5300 1.5
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
LOT BLOCK SUBDIVISION
PARCEL NO.
OWNER
3 .7:1 v?9./A.- zS . /o
MAIVNG ADDRESS
PHONE PHONE
CONTRACTOR
4. t' X/Pi /1;4...--'e
ADDRESS
>-"P 47e rx_
LICENSE EXPIRES
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to
North 'South East I West
Size of Parcel Zone Classification
Type Const.
Occupancy
Residential 0
Commercial
Sprinklered
CYes ENo ❑Req'd.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
ZIP
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
TO Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OFOTHER
WORK L. BLD. ❑ PLMB. �MECH. ❑ M.H. ❑ POOL ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
CertifI. of Exempt.
or Variance
Required Yes❑ No❑
Received Yee❑ Nor
Number
DESCR E WORK
VALUATION SOUR E GAS ELECTRIC
9 UTIF
LITIES `"C.J
`2
Shorelines/Flood Hazard Plans Required ❑
Yes- NotApplic. ❑ Received ❑
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public ❑ 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
S
OWNER OR AGEIGNATURE OF rt� liid/i�
APPLICATION /� /' 3
DATE d' d
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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
V3
PERMIT UMBER
04* *14.00
*14.006
A *000 0
8368
08-30-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08-30-P 3
DATE ISSUED
Z *
PERMIT NO. O O O AL