1984, 03-08 Permit: 84A-1964 FurnacePLANNUMBERAPPLICATION/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
STREETADDRESS PARCEL NO.
2. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWIj§R I PHONE PHONE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04,4 — ,3&
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0.
DATE ISSUED PERMIT NO.
* 2 (1, c" '
TOTAL
CL
C
C
U
u
`;
A G AD` DRESS `1 I IP
Actual Set Backs in Feet to:
North I South East
I West
CONTRACTORLICENSE
EXPIREi PHONE_
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4.
AMDRESS ZIP
Type Const. Occupancy
Sprinklered
r _L.
Dyes ❑No ❑Req'd.
DESIGNER PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
J.
ADDRESS ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE �IEW El ALT. El AD' N. ❑RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7.
WORK ❑ BLD. ❑ PLMB�MECH. ❑ M.H. ❑ POOL C1OTHER
Certifi. of Exempt.
Required
Yes❑ No 11
Number
or Variance
Received
Yes ❑ No ❑
8'
DESCRIBE WORK n�
Shorelines/ Flood Hazard
Plans Required ❑
1r
Yes Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS
ELEQTRP
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private 13FEES
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-
Building
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
p�
OWNER OR AGENT-� DATE _ ___
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04,4 — ,3&
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0.
DATE ISSUED PERMIT NO.
* 2 (1, c" '
TOTAL
CL
C
C
U
u