1983, 12-06 Permit: 83B-2285 Gas ConversionPLAN NUMBER
APPLICATIQN/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
1. g—/OSA7
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3.
OWNER
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs In Feet to:
North 'South
[East
West
4.
CONTRACTOR
ADDRESS
E - n '7- A/r1a_.
LICENSE EXPIRES
5/// cid"
PHONE
Size of Parcel
Zone Classification
Residential 0
Commercial 0
ZIP
ft2u7
Type Const.
Occupancy
Spr nklered
DVes DNo ❑Raged.
5.
DESIGNER
PHONE
New Const. Valuation
Remade ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deas
Uncv. Deck
Fin. Basement
Unfin. Basement
7.
8.
TYPE 0 NEW
OF D'BLD.
WORK
DESCRIBE WORK
O ALT. D AD' N. D RPL. D MVE.
D PLMB. XMECH. D M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or variance
Required Yes❑ No❑
Received Yea❑ No❑
Number
9 4n-- Ivo
Shorelines/Flood Haza d
Yes D Not Applic.D
Plans Requ red D
Received 0
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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
SIGNATURE OF C APPLICATION
OWNER OR AGENT — DATE / :274-/c–
SPECIAL
74-/.cSPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mach.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ /� c
PERMIT NUMBER
04* *tao0
*1800
A *0.00
228.42
12-06-83
2 6479.
O
W
J
IA-
WHEN
Y
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Ilk 0 6 - 8 3
PERMITN?..2 8.5 •2
*18.0ff°r*