1984, 01-19 Permit: 84A-581 Furnace, Heat PumpPLAN 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
STREET ADDRESS
LOT
BLOCK
SUBDIVISION
c
OWNER-
rT I `Tne
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
MAILING ADDRjS t
i 1 q
ZIP
Cal
Actual Set Backs in Feet to:
North 'South [East 1 West
CONTRACT -QR
ADDRES
c. iLf/ ss/CO—
LICENSE EXPIRES
/0—Vy
PHONE
7333
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
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
I.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
r
TYPE (`NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
OF
WORK ❑ BLD. 0 PLMB.. MECH. ❑ M.H. 0 POOL ❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes .0 No❑
Number
3.
DESCRIBE WORK
UCI S 14T)
J ?/ Cl tic. / L[/7/V /1-4.r7 17
VALUATION
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes NotApplic. ❑
Plans Required ❑
Received ❑
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 other state or local law regulating construction or the performance
of construction. SEE REVERS . SIDE • R REQUIRED INSPECTIONS
SIGNATURE OFAPPLICATION 7_S
OWNER OR AGENT �.�� ` DATE
SPECIAL APPROVAL 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 $
PERMIT NUMBER
e4A
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEcIS3UEil PERMIT N(;. 8. 1 z * 1 9. l 0 FAL