1983, 12-21 Permit: 83B-2710 Gas BurnerPLAN 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. //4/ is 754/
2.
3.
LOT
BLOCK
PARCEL NO.
SUBDIVISION
LEGAL DESCRIPTION:
/cJ
OWNEF1 / Q C GZ/J >1/4,4
MAILING ADDRESS
Z.£2,7-11-2...—
cONTRACTOFLI
:'t-f���
4.
(ADDRESS
L . // 61224,_/-y,.,i�°tet
PHONE
9a47—
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
ZIP
9(92 J 6
PHONE
a6 Zg3
ZIP
�'i; a O F
Actual Set Backs in Feet to:
North (South
Size of Parcel
11 Zone Classification
East I West
Type Const.
Occupancy
PHONE New Const. Valuation
Residential ❑
Commercial D
Spr'nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
ZIP Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD' N. E RPL.
7. OF
WORK ❑ BLD. ❑ PLMB'MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes No
Received Yes No'l
Number
DESCRIBE WORK
8. z
VALUATION
9.
'SOURCE
UTILITIES
'S
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes El Not Applic. ❑
Ownership
Public ❑ 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT at A(I(,e (,[ec-
APPLICATION
DATE /c2— /9'1, i
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
S''GU lay t5 0
6/K Pit/nice,
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans
Required E
Received LI
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
g3%lO
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE
SSUED2 1 —85
2711.05 *18.000_,
TOTAL
PERMIT NO.