1983, 03-22 Permit: 83A-2106 FurnacePLAN NUMBER APPLICATION/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.
1. 3 -R49,X R0,42>
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNERPHONE
D, K, iz�-4-/ NG-
.
I W z/ -S93i
PHONE
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
/� / R p �/ 4 1✓a �e 1
2, 7 A f} K O S PV WA
Ad
+Q • ni:F
49
North South East
West
CONTRACTOR �T/� n
LION EXPIRES
PHONE w1��7r
T
Size of Parcel
Zone Classification
Comidmercial0
4. �� t.T'
�,J
ADDRESS C p�
50,51 ,c:. T/Q L—N T sS + QMAlkj W/1
ZIP
Q 6
Type Const. Occupancy
Sprinklered
Oyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
❑NEW ALT. El AD'N. El RPL. El MVE.
7 OF
WORK 1:1 BLD. ❑ PLMB. f�MECH. El M.H. El POOL ❑OTHER
Certifi. of Exempt. Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8 �DESC��WCORK I�u i'Vi
L
Shorelines/ Flood Hazard
Plans Required
OilT f,(/V1 IWO T/}- —
Yes❑ Not Applic. ❑
Received ❑
VALUATION.t SOURCE
OF
9.
GAS
ELECTRIC
PUBLIWATCO SEPTIC SEWAGE
Ownership
FEES COLLECTED
! UTILITIES
PRIVATE ❑ SEWER ❑
Public ❑ 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
work will be complied withJetbetfter s cified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cel the provisio s of any other state or local law regulating construction or the performance
of construction E REVERK SI REGUMD INSPECTIONS
Plumbing
SIGNATUR OF APPLICATION
OWNER OR ENT DATE
Mech.
SPECIAL APPROVALS
S ECTAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
� A a .may g
Plan Check
Env. Health
I � � '� j L./
SEPA
Planning
j � � V
Modular/
Fire
MFG. Home
Prevent.
Utilities
SEPA
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. ✓1 7� IN 180 DAYS
Other (Specify)
PERMIT NUMBER
p
TOTAL $ =�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE RUED PERMIT 2010. 6 23
* 16 0.0,0-j
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C
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