1984, 02-21 Permit: 84A-1412 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
STREETADDRESS PARCEL NO.
ZI
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER ' / r f?
(t
PHONE
PHONE
3.
MAILING DDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
CONTRACTOR
LICENS�EE PIRES
1"
PHONE
-�1y %
Size of Parcel
Zone Classification
Residential
Commercial ❑
4. rL+
.A� 3
ADDRESS I
ZIP
Type Const.
Occupancy
Sprinklered
f_7e 7
1
1
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfln. Basement
s.
TYPE fRNEW ❑ALT. ❑ AD'N. ❑RPL. El MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. WORK El BLD. ElPLMB. XMECH. ❑ M.H. ❑ POOL El OTHER
OF
Certifi.ofExempt.
Required
Yes No❑
Number
or Variance
Received
Yes❑ No[-.)
DESCRIBE WORK
8•
Shorelines/Flood Hazard
Plans Required ❑
Yes Not Applic. ❑
Received ❑
VALUATION
SOOUFCE
GAS
ELECTRIC
WATPUBLIC ❑
SEPTIC SEWAGE
1
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
I hereby certify that 1 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-
Building
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 /J� APPLICATION
OWNER OR AGENT DATE
'Fy
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
Utilities
Plans i i I I PERMIT IS NONTRANSFERABLE
Exam. I 144.4 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buikding ' % Lid I N 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $tiv'
PERMIT NUMBER
rfv
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
4
ll� �1.� 20.00°�
DATE ISStD`2 l:. —� PERMIT flo. `` TOTAL
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