1984, 03-19 Permit: 84A-2363 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
STREET ADDRESS
1. 37d •
LO BLOCK SUBDIVISION
2.
OWNER 1�
3. M91LING_ 7o 7 V
CON RACTR !r
4.
ADritSS
LICENSE EXPIRES
PHONE
ZIP
•
DESIGNER
ADDRESS
CHANGE OF USE FROM
•
ZIP
TO
TYPE i NEW ❑ ALT. ❑/ AD' N. 0 RPL. ❑ MVE.
7.OFWORK ❑ OTHER
❑ BLD. 0 PLMB,A MECH. 0 M.H. 0 POOL
DES
8.
VALUATION
9.
SOURCE
UTILITIES
GAS
�
ELCTRIC WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
New Const. Valuation
Cover Deck
No. Baths
East
West
Zone Classification
Remodeled Valuation
Residential 0
Commercial 0
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No
Received Yes❑ No fl
Shorelines/ Flood Hazard
Yes❑ Not Applic. 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl'cation 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 : ncel the provisions of any other state or local law regulating construction or the performance
of construction. SEE 'i VERSE SIDE FOR • UIR A2 INSPECTIONS
SIGNATURE OF OWNER OR GENT ` a. . /J ;ME - DATE APPLICATION '2 _, ) Q� Z� /,/
e / v 1
SPECIAL APPR • A S
PRELIM. FI AL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
70-
SPECIAL
CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *2000
*20.006
A *000 0
23622
03-19-84
2 6479.
0
Lia
J
I.L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-19-84
DATE ISSUED
PERMI; .`. 3 z *2 0. 0 0 TOTAL