1984, 02-21 Permit: 84A-1423 Furnace PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY e0 - /'2.3
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS „: PARCEL NO.
1. ,t,/ 7ig 1/, - ,____,
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERV.-, PHONE PHONE
3. U2( e. .'/. .. / ,cam lz,—5324-
MAILING ADDRESS /. ZI Il z / North Actual Set Backs in Feet South to:
[East I West
it/' 7/C) Lt1 (1. .
CONT ACTOR - dLICENSE EXPIR S// PHO ��.. ;7 2 Size of Parcel Zone Classification Residential❑
4. ���-"l,/.` �,7_yph.:? '?^� G% ` /- 'Y // •/1 Commercial❑
L; x c C
- r,
ADDRESS`/} ZI Type Const. Occupancy Sprinklered ( v
It�, . I. , �2z..-1 ❑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 -
c_ -- t_ I — Q' i
CHANGE OF USE FROM TO Cover Deck ' Uncv.Deck Fin.Basement Unf in.Basement
6. . ,/
Y.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. El AD'N. El RPL. ❑ MVE.
7. OF El OTHER
WORK El BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
/` or Variance Received Yes No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. �' rJ z - -Q--�9" Yes Not Applic.❑ Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER❑ Public❑Private❑
UTILILITIES
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 Building
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 Plumbing
SIGNATURE OF /', ' APPLICATION
OWNER OR AGENT � 1.7 f fM ),A, t�'_� ik:-(41- DATE /� Mach. _Zf ) "
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) '
PRELIM. FINAL DATE Plan Check
Env.Health
/ SEPA
Planning 67 `' �;5)O Modular/
/ C MFG.Home
Fire . - a-
Prevent. O
c /2 t Other(Specify) V
EngineerC. �� yC ) % W
J
LL
Utilities TOTAL $- � -«)-'
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ft IN 180 DAYS r ow
'` -7 z j DATE.iSiUUD2 1 -8 4 PERMIT1N$.2. 3 5 * 2 0. 0 0 O AL