1983, 10-11 Permit: 83B-0231 Furnace, PipingPLAN 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
STREET ADDRESS
1.
LOT
2.
BLOCK
Pro ye S
SUBDIVISION
PARCEL WO. e
OWNER
3 �nln v. 2�IC n R
MAI ING ADDRESS
f. Q , o)C I Li- bQ
4.
CONTRACTOR
PHONE
PHONE
9 2-4 -638q (o
LICENSE EXPIRES
ZIP
99.zi4-
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South Est I West
Size of Parcel ► Zone Classification
Residential 8
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE C44W ❑ ALT. ❑ A N. ❑ RPL. ❑ MVE.
7. OF ❑
WORK BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif 1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ No❑
Number
8.
DESCRIBE WORK
9.
LG,OCo
SOURCE
F
UTILITIES
VALUATION
GAS
(7\
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Plans Required ❑
Received ❑
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC D
SEWER E
Ownership
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
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 r < APPLICATION /C 3
OWNER OR AGENT yam`' . DATE_/j —
SPECIAL APPROVA ' SPEC AL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
0-o, Oo i TLA EV,vv.0...-r-C
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
S.31Z. oast
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4S3UED1 1 8 3 PERMIT Ng .5. 1 z
*18.0O�OAL