1984, 02-21 Permit: 84A-1430 FurnacePLAN NUMBER APPL LCAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
1. /s-' .S' c�.� � Q�
2. LOT BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3. -,v J
MAILIN ADDRESS
ZIP
Actual Set Backs in Feet to:
S
North South East
West
CONTRACTOR
�L2
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4.
TZ d�" T7r7 :'e
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
L/1<4
957'zz--I'❑Yes
❑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
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TOF YPE 13 NEW ❑ALT. El AD'N. El RPL. ❑ MVE.
7.
WORK El BLD. 11 PLMB. CMECH. El M.H. 11 POOL ❑OTHER
Certiff.ofExempt.
Required
Yes❑ No❑
Number
or variance
Received
Yes❑ No
8. DESCRIB.%WO1-K/� / ��
Ses0inesNotA pezar❑d
Plans Required 0
Z / �G2✓
Received ❑
VALUATION
9•
SOU
GAS
ELECTRIC
PUBLIC ❑
SEPTWATER IC ❑
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private ❑
1 hereby certify that 1 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 FORREQUIREDINSPECTIONS
Plumbing
SIGNATURE OF
OWNER OR GENT ��/��'«� DATE
Mech.
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam, PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. 21Zj
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMB,E
30
ZZI Cs
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
-:r p
DATEAUE� 1. 0
— 4 PERMITINO. � Fl o
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