1983, 06-21 Permit: 83A-5569 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
1.
2.
STREETADDRESS
LOT
BLOCK
/ C Y.:2. `f V+ ---
SUBDIVISION
4.
OWNER K' iI
�
. - /
MAILING ADDRESS
wG�
CONTRACT! / it
Le
PHONE
PARCEL NO.
PHONE
ZIP
LIC/N d PI S ,�3 —77 7
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North jSouth
East West
Size of Parcel
Zone Classification
ADDRE t<9 5-4) 5- / V -1/141v'
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
7.
Z 1 ( 7
PHONE
Type Const.
Occupancy
Residential E
Comrnercial ■
Sprinklered
❑Yes No ❑ Req 'd.
ZIP
TO
TYPE E NEW 43/ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
OF ❑ BLD. ❑ PLMB. Et MECH. n M.H. ❑ POOL
WORK
❑ OTHER
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Fin. Basement
Greenhouse
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yeses NoL
Received Yes No -1
Number
8. DE R
� GLri[ 4.7.LY>....f4.
•.e..e2rr R e
VALUATION
9.
SOURCE
UTILITIES
GAS 1
Shorelines/Flood Hazard
Yes CI Not Applic. ❑
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC C
SEWER =
Ownership
Public ❑ Private C
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 thls 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 OFr APPLICATIO
OWNER OR AGENT _ DATE
SPECIAL APPRO LS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
c&/,2
Fcl t 55 1
(,5774, AA'A
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received
FEES COLLECTED
A/0 `r-'
Building
Plumbing
' Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
53A _ 5 'i
04*
N
556.82
06-21-83
2 6479.
*1600
*16006
*0.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.Z
8' " 5 6.9
. " 9
DATE ,ED2 1 -
PERMIT NO. z
*1 60 0
o
0.1—
TOTAL