1983, 10-07 Permit: 83B-117 FurnacePLAN NUMBER APPLICATION/PERMIT T« PERMITNUMBER `fir
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 PARCEL NO.
1. , '5- 3
LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
2.
O NER
PHONE
PHONE
3.
MAILINGA96RESS
ZIP
Actual Set Backs in Feet to:
�C'i�L.rs
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
7
Commercial ❑
4.
ADDRESS A/ %
-Y Z y /v, N —
ZIP
4:5Z9 �G J
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
J.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE El NEW E3 ALT. ❑ AD'N. El RPL.
ElMVE.
7 OF
❑OTHER
WORK ❑ BLD. ElPLMB. ❑ MECH. ElM.H.
El POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBEWORK /
8• e
Shorelines/ Flood Hazard
Plans Required El
p� l" _
/ G C/
Yes❑ Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
UTILITIES
yy��
n✓
PRIVATE C1
SEWER El
public ❑Private ❑
1 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-
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 IN PECTIONS
Plumbing
SIGNATURE OF
APPLICATION�-
�- �d � F�
OWNER OR AGEN -�. ���
DATE
Mach.
SPECIAL APPROVALS
PRELIM. FINAL D.
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
Plans
Exam.
Building 4i,/
Tech. ._7
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
A
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Pian Check
SEPA
Modular/
MFG.Home
Other (Specify)
ca- ITOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
(l 7 — 8
DATEISUEDrz3 PERMIT NO. 1, 7 0
* U �O�AL