1983, 10-12 Permit: 83B-1020 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS''IARD TO MAKE 3 COPIES
1.
STREET ADDR�$S� / / �y % �1 OOO— /Z1' 1
�'/1 '
PARCEL NO.
BLOCK
SUBDIVISION
/ 6-Z /L"
M AD/% >/
PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North [South [East West
NTRACTOR „.„.. •
REBS�
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
P ONE 't•'
/ Y/7s'
t"./-_-6-? --
Z
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Spr'nklered
❑Yes No Req 'd.
PHONE
New Const. Valuation
Remodeled 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
7. OF
WORK ❑ BLD.
❑ ALT. ❑ Aq' N. ❑ RPL.
❑ PLMB. ECH. ❑ M.H.
❑ MVE.
❑POOL ❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesE No
Received Yes No❑
Number
8.
DESCRIBE WORK
Shorelines/Flood Hazard
Yes NotApplic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE f/ GAS
UTILITIES
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
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 a cel the provisi s of any other state or local taw regulating construction or the performance
of construction. SEEREVERSE SIDE OR REOUIR INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR A 41 6/(/2 //1' ' — -- DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
i/
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 $ t "
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSgED 2 8 _ 8 3
PERMITN1L L. 0 5 *1 6. 0 OTi IAL