1983, 11-07 Permit: 82B-1388 FurnacePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON J SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
or Variance
Received Yes El No❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
G {A S IF --ft ry A tE � S' i -M--. 44, C ry (
Yes ❑ Not Appl ic. ❑
Received ❑
OWNER
PHONE
GAS
PHONE
WATE O
SEPWAGTicE
OwnershipPUBLI
]
3.
b(JV'LJ Lr T4 "
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
MAILING ADDRESS
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
ZIP
Actual t Backs in
Feet to:
thority to violate or cancel the pr isions of any other state or local law regulating construction or the performance
N. 31(o LIC," 6,
of construction. SEE REVERS01bE FOR R UIRED INSPECTIONS
Plumbing
QC(O l
North
South East West
Mech. L� QCT
SPECIAL APPROVALS
CONTRACTOR
LICENSE EXPIRES
PHONE"Size
of Parcel
Env. Health
Zone Classification
Residential ❑
4.
f'='r'- 1{E.e°rk SE2�IiCl:
CtZZ'�'3�G
SEPA
Planning
Commercial
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
l 7
' , Z - t `
MFG. Home
Fire
❑Yes ❑No
❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Other (Specify)
Fnaineer
i
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE El NEW E3 ALT. El AD'N.
El RPL.
El MVE.
7.
OF
❑OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH.
ElM.H.
❑ POOL
Certifi. of Exempt.
Required Yes❑ No❑
Number
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingf, j7 IN 180 DAYS
Tech. l
TOTAL $ ts'�.o
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATEfSSUEDa ( _ PERMITII� 8, 8 z * a 10 -AL
a
O
U
W
J
U_
or Variance
Received Yes El No❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
G {A S IF --ft ry A tE � S' i -M--. 44, C ry (
Yes ❑ Not Appl ic. ❑
Received ❑
VALUATION I
9•
SOOUFCE
GAS
ELECTRIC
WATE O
SEPWAGTicE
OwnershipPUBLI
]
FEES COLLECTED
I
UTILITIES
PRIVATE ❑
SEWER ❑
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
Building
work will be compiled with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the pr isions of any other state or local law regulating construction or the performance
of construction. SEE REVERS01bE FOR R UIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATI
OWNER OR AGENT DATE �f
Mech. L� QCT
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Other (Specify)
Fnaineer
i
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingf, j7 IN 180 DAYS
Tech. l
TOTAL $ ts'�.o
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATEfSSUEDa ( _ PERMITII� 8, 8 z * a 10 -AL
a
O
U
W
J
U_