1984, 04-09 Permit: 84A-3134 FurnacePLAN NUMBER
APPL ICAT-N./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.
c 9 o
PARCEL NO.
r
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 2/,
MAILI ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North ISouth
CONTR TORLICENSE EXPIRES
/ I" 7_2e's/ -.z -s
4. A DRESS ��----��
/ 7c9.-3 t-/^r9i7r/ s
DESIGNER
•
PHO E
Size of Parcel
East
Zone Classification
West
Residential Li
Commercial ❑
ZIP
9'7,22
7
Type Const.
Occupancy
Sprinklered
❑Yes ❑No CReq'd.
ADDRESS
CHANGE OF USE FROM
TO
PHONE
ZIP
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
TYPE (Z5—NEW ❑ ALT. C AD' N. ❑ RPL. ❑ MVE.
7- OF
WORK ❑ BLD. ❑ PLMB. ECH. El M.H. ❑ POOL
❑ OTHER
NO. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ NoC
Received Yes❑ Nof7
Number
DESCRIBE WORK Shorelines/ Flood Hazard
8//7_574-6/ /01/ C�(,.lAfr.>�a [� .1.,K� Yes❑ Not Applic. 0
VALUATION SOURELECTRIC WATER SEWAGE Ownership
9 OF X� PUBLIC ❑
PRIVATE 0 SEPTIC 0
SEWER 0 public 0 Private 0
i�
UTILIT
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 DATE
Plans Required
Received
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
S2(7/
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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)
TOTAL $
PERMIT NUMBER
'i 1-3i
04* *2000
*20.006
A *C00
313.3
04-09-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUEd' 9— 8 4 PERMIT NO. 4 z
*20,00TOTAL