1983, 10-18 Permit: 83B-524 BoilerPLAN 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 _ ,cam PARCEL NO.
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER
3.
MAILING ADDRESS
CONTRACTOR LICENSE EXPIRE
DRESS
5.
QNE PHONE
ZIP
DESIG
North
PHONE Size of Parcel
Z!P Type Const,
PHONE New Const. V
South I East I West
cone i,iassmcauon Residential ❑
Commercial ❑
Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
I Remodeled Valuation Total Bldg. Floor Area
9 UTILITIES PRIVATE ❑ SEWER ❑ Public C Private C
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 Building
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 Plumbing
SIGNATURE OF APPLICATION/ �y Mech.�
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE r' Plan Check
Env. Health d/L 121�/4e: /o
SEPA
Planning
Modular/
MFG. Home
tngineer
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingtp IN 180 DAYS
Tech.
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE ISSUED- > PERMIT NO5 z * 0 OTOTAL
iS
C
L
LL
LL
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem(
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑NEW
❑ALT. El AD'N. X RPL.
El MVE.
%
El BLD.
ElPLMB. [R'MECH. 11M.H.
El POOL ❑OTHER
Certifi. of Exempt.
Required
Yes Ll No❑
Number
WORK
or Variance
Received
Yes 1-1 No❑
8
DESCRIBE WORK
/7
Shorelines/ Flood Hazard
Plans Required ❑
Yes El Not Applic. ElReceived
El
VALUATION
I SOOUFCE
GAS
ELECTRIC
PUBLIC El
SEWATER f PT C ❑ AGE
Ownership
FEES COLLECTED
9 UTILITIES PRIVATE ❑ SEWER ❑ Public C Private C
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 Building
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 Plumbing
SIGNATURE OF APPLICATION/ �y Mech.�
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE r' Plan Check
Env. Health d/L 121�/4e: /o
SEPA
Planning
Modular/
MFG. Home
tngineer
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingtp IN 180 DAYS
Tech.
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE ISSUED- > PERMIT NO5 z * 0 OTOTAL
iS
C
L
LL
LL