1984, 03-22 Permit: 84A-2472 FurnacePLAN NUMBER APPLICATIO ,'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 PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER i�
PHONE
PHONE
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North I South East
West
CONTRACT R
LICE SE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
�. -
Commercial E)4.
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
1
9 ?t3 7
Dyes ❑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.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. ❑ AD' N. ❑RPL. ❑ MVE.
7. OF
WORK El BLD. ❑ PLMB. XMECH. ElM.H. El POOL ❑OTHER
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yea❑ No El
DESCRIBE WORK /�
8
Shorelines/ Flood Hazard
Plans Required ❑
/ Gtu-� st !.0 _.•
Yes Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public❑iPrivate ❑
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 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 1 APPLICATION % /
OWNER OR AGENT ®� A_ DATE
�/ !
Mach.y
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Plan Check
SEPA
ModularI
MFG. Home
Other (Specify)
POW
O NU� E-7
yl�T
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Exam. 1 1PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS ) o I r o
55
Tech. 3 DATEYSSUEDL' � � � PERMIT�� �' � � L f ` � � flO'VAI
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