1983, 10-03 Permit: 83A-9858 Furnace, PipingPLAN 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
STREET ADDRESS
1.
LOT
2.
BLOCK
3.
OWN
SUBDIVISION
'.YC rR tI`��
PHONE
MAILING ADDRESS
CONTRACT
4. t:. r( S Ht Z r/7 r
ADDRESS
5.
DESIGNER I
PHONE
ZIP
LICENSE EXP' ES PHONE
57-,115V yrs 47$/,
ZIP
i2,�d')
PHONE
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPE J'NEW ❑ ALT. ❑ AD' N. 0 RPL. 0 MVE.
7. OF WORK 0 BLD. 0 PLMB. f MECH. 0 M.H. 0 POOL El OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South [East I West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Residential ■
Sprinklered
❑Yes 0 N ❑ Req 'd.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Fin. Basement Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yes Li No E Number
Received Yes❑ Nor
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard Plans Required ❑
YesE Not Applic. ❑ Received ❑
Ownership
Public 0 Private 0
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
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 OF '/ APPLICATION
OWNER OR AGENT v'- C° Ct DATE �
OWNER OR /5ii
SPECIAL APPROVALS S CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
-)(3
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
(1; .0a
TOTAL $
PERMIT NUMBERO, (J,
n, * *1800
*18006
A *0,00 0
985,78
10-03-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
LU
DATE ISSUED
PERMIT
8NO.85.85 *18.0UT.T,L