1983, 11-08 Permit: 83B-1426 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
STREET DDRESS I PARCEL NO. r
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE
MAILING ADDRESS
1�5. le'_7 Ile
CO TRACTOR LICENSE EXPIRI;
4. ,DIIWJ✓ ,GS L ' ti f'rte
ESS
'r?/9 A&*-"
5. ADDRESS
CHANGE OF USE FROM
6.
TO
� Actual Set Backs In Feet to:
Z
7 North South East West
PHONE Size of Parcel Zone Classification Residential ❑
171 1 Commercial ❑
Z Type Const. Occupancy Sprinklered
�J �s ❑Yes ONO ❑Req'd.
PHONE New Const. Valuation Remodeled Valuation I Total Bldg. Floor Area
ZIP I Main Floor I Upper Floors
TYPE ❑ NEW ❑ ALT. ❑ A 'N. �(RPL. ❑ MVE.
7. OF El OTHER
WORK El BLD. ❑ PLMB. ECH. ❑ M.H. ❑ POOL
No. Baths i No. Floors i No. Fin. Rooms i No. Dwellings
Certifi. of Exempt. Required Yes L1 NO LJ rvumoer
or Variance Received Ye. -
Shorelines/ Flood
esShorelines/Flood Hazard I Plans Required ❑
8.
Yes ❑ Not Applic.T❑
Received ❑
VALUATION
OURCE
GAS
ELECTRIC
WATER
PUBLfC F1
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9•
UTILOIF
PRIVATE ❑
SEWER ❑
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
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 INSPECTIONSAPPLI
Plumbing
SIGNATURE OF�J ,,
Mach.
OWNER OR AGENT DATECATION�����'
Plan Check
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) �,
PRELIM. FINAL
DATE
/ ..--, / jG ��%ff.►✓/v�
���
Env. Health
/� < ,'--�"� �!1✓
/'
Modular/ Modular)
Planning
MFG. Home
Fire
Prevent.
Other (Specify)
Engineer
$
Utilities
TOTAL
SEPA
WHEN MACHINE VALIDATED
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Plans
stn•
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
PERMIT NUMBER
IS SPACE,
-7
IN 180 DAYS 2�6 O' 0
Building
Tech. DATC4UEPERMI1414. tdTAL