1983, 11-04 Permit: 83B-1307 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
STR/ALJEET gpP5R
2.
3.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
LOT 1 BLOCK 1 SUBDIVISION
O
4.
5.
71116-7W8
NG A S /V e.a .d
C NT T
ADD' :Z-5/
DESIGNER
PHONE
14037
LICEN Fc/XARE$
4.0eie27k4._
PARCEL WO
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 1South [East 1 West
P� 4975
of Parcel
ZIP q J
PHONE
Type Const.
Occupancy
New Const. Valuation
Zone Classification
Residential ❑
Commercial ❑
Spr nklered
❑Yes ❑No Req 'd.
Remode ed 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 ❑ NEW
7. OF
WORK ❑ BLD.
O ALT. ❑ AD'N. *PL.❑ MVE.
❑ PLMB.y,MECH ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No Cl
Number
DESCRIBE WOR Shorelines/FloodHazard
8. gra'� Yes Not ofApplic. ❑
Plans Requ red ❑
Received ❑
SOURCE
UTILLIITIES
GA S/
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
VALUATIoy,
9. //395ti
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 wh
thority to violate or can - e provisio
of construction. SE - • EVERS
SIGNATURE OF f,
OWNER OR AG'
Ownership
Public 0 Private 0
S
ified herein or not. The granting of a permit does not presume to give au -
of any other state or local law regulating construction or the performance
= • RE • . 'ice. INSPECTIONS
SPECIAL APPROVALS
/•i //iG/
41111WCIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
APPLICATION
DATE
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
1y
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)
/O0
t
°b
/6 4
TOTAL $
PERMIT NUMBEcI*1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11-04 i O.7 -
DATE ISSUED
* 10.00 0
PERMIT NO. TOTAL