HomeMy WebLinkAbout1984, 02-21 Permit: 84A-1432 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.
STREET ADDRESS
/f./;3 7
LOT BLOCK
1 ---
SUBDIVISION
PARCEL NO
OW R
3
MAILING ADDRESS
PHONE
4.
CONTRACTOR
LICENSE EXPIRES
PHONE
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South IEast I West
Size of Parcel
Zone Classification
Residential ❑
Commercial D
ADDRESS
/..',Zit%
Type Const.
Occupancy
Sprinklered
EYes ONo ❑Req'd.
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF r] OTHER
WORK ❑ BLD. E PLMB.-fS�v1ECH. ❑ M.H. ❑ POOL
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
Fin. Basement
G eenhouse
Unfin. Basement
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesE NoE
Received YesO NoP
Number
DESCRIBE
VALUATION SOU
9 UTILITIES
l/ C c, 4 -
GAS
ELECTRIC
- kVA
WATER SEWAGE
PUBLIC ❑ SEPTIC E
PRIVATE 0 SEWER ❑
Shorelines/Flood Hazard
YesP Not Applic. E
Ownership
Public 0 Private ❑
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 REVERS
IDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGE ->'� <' DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required E
Received :i
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
64A-
04* *2200
*22.006
*000 d
14312
02-21-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4siu12 1 — 8 4
PERMITINiqq
f. 5. 2
*222.00 AL