1983, 10-20 Permit: 83B-658 FurnacePLAN NUMBER APPLICATION /PERMIT r PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 r
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION: P
2.
OWNERPHONE
PHONE
3. s
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
_<,!,'..' Pi
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone
Classification
Residential ❑
_
Commercial ❑
4.
ADDRESS`
ZIP
Type Const. Occupancy
Sprinklered
3,z as,
-_ 5' G�
[]yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
per Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
i Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE 1-1 El ALT. Fr�AD'N. ❑RPL. 1-1 MVE.
7 O F El OTHER
WORK ElBLD. ElPLMB. ❑ MECH. ❑ M.H. ElPOOL
Certifi.ofExempt.
Required
Yes L' No E-,
Number
or Variance
Received
Yes El No❑
DESCRIBE WORKrll %�
8'
Shorelines/ Flood Hazard
Plans Required El
__"i, 0/n /� P f �/f f' .t./ Zi
Yes El Not Applic. ❑
Received ❑
VALUATION
S RCE
OF
GAS
ELECTRIC
WATER
PUBLIC 1-1SEPTIC
SEWAGE
11
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
public El ❑
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 IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF � 4 APPLICATION �y
OWNER OR AGEN ��/! .� . �C`�'t _ _ D ^ _ __� �d �-3
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE y ,p T /�
Env. Health / ' �� t^%�/�� 7a / �`t_ !�L-d/lam � - Q � !�
r���P �x�«r.-Ge
Planning
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS �1
BECOMES A PERMIT.
DATE�4uii � U Q PERMIT N6. 5-8 o
* 16.0 0 *0YAL
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