1983, 07-20 Permit: 83A-6744 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.
2. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER PH ✓d PHONE
MAILING ADDRESS
Zpg
Actual Set Backs in Feet to:
_S X1�U !N
-/ {
North South East
West
LM
CONTRACTOR LIQ+ SE EXP ES
PHONE
�'
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
A
71!
Type Const.
Occupancy
Sprinklered
��CRESS
c,
❑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.
��
TYPE 'ALT.
Baths No.
Floors
No. Fin. Rooms
No. Dwellings
13L+�l ElNo.
NEW AD'N. ❑ RPL. F-1MVE.
7. ❑OTHER
WORK El BLD. 13 PLMB. 9-IMECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WO
8
Shorelines/ Flood Hazard
Plans Required ❑
ALL
Yes Not Applic. ❑
Received ❑
9 VALUATION
SOOUFCE
GqS �,
ELECTRIC
PUB IWATER
SEPTIC ❑
I
��hip
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE"
provitions included onA'yjyya
l d
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 REODUIRED INSPECTIONS
Plumbing
SIGNATURE OF � � .�i� G APPLICATION /�_ J9, fi �)�
�f•nd�
OWNER OR AGENT / DATE
Mech.
SPECIAL APPROV
PRELIM. FINAL
Env. Health
Planning
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR N
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Plan Check
PERMITNUMBER
6 _
SEPA
Modular/
MFG. Home
Other (Specify)
- eg o
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE �s{�IED 2 0— 8 3 PERMIT 40? 4, 4 z
*18,000,
TOTAL
u