1983, 06-21 Permit: 83A-5625 FurnacePLAN NUMBER APPL ICAT ION /PERMIT PERMIT NUMBER
SPOKANE COUNTY -- DEPARTMENT OF BUILDING & SAFETY SCD r'J
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARPEL NO.
1. /3z5 5 tet/BJMM Lwrs ICO
2. LOT BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3. G Z. 51VIV -- U 9Z2
MAILING ADDRESS/ �_ / Z ua t Backs n Feet to:
3 ZGt/�.s '<'r North South East West
CO TRACTORLICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential ❑
4. Commercial 13
AD R�fESS 'L ZIP q Type Const. Occupancy Sprinkiered
U. `7344�i�-� ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
ADDRESS ZIP Main Floor Upper
s. r Floors GaragelStorage Greenhouse
CHANGE OF USE FROM TO— -
Cover Deck Uncv. Deck Fin. Basement Unf in. Basement
TYPE 13 NEW El ALT. D AD'N. RPL. El MVE. No. Baths No. Floors No. Fin. Rooms No. Dwellings
OF
7 WORK El BLD. ElPLMB.OMECH. ❑ M.H. El POOL ❑OTHER Certifi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRIBEWORK _ /,/ �,♦ Shorelines/ Flood Hazard Plans Required
8 �/1✓5�/� LC �iS�G'tX 6�� Ii,2.� %� � ' ��G�LYS e;, ./, Yes❑ Not Applic. ❑ Received ❑
VALUATION SOOURCE GAS ELECTRIC PUBLIC ❑ EPT CG❑ Ownership FEES COLLECTED
9 UTILITIES PRIVATE ❑ SEWER ❑ Public O Private ❑
1 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 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 Plumbing
SIGNATURE OF APPLICATION �� �y�
OWNER OR AGENTS DATE Mach. -Lac=--L
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG.Home
Fire
Prevent.
Utilities
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
'r hdmg (p„ IN 180 DAYS
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQJLIE; _ 8 3 PERMIA6. 2. 5 1z
* 1 6.0 0 J04L
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