1983, 07-01 Permit: 83A-6060 FurnacePLAN NUMBER APPLICATION/PERMIT W
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY 530oi,5
NORTH 811 JEFFERSON/ SPOKANE, WASHIWdTON 99260 / (509) 456-3675
%1� APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
ZO N�ER PHONE PHONE
!t ,i'
3 MAILrING DRESS ZIP Actual Set Backs in Feet to:
J le,7 � North South East West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential El
4E d 4 v� J - t Commercial ElADDRESS yt ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
c
v.
ADDRESS
ZIP
Floor
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
I
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TOF YPE ❑NEW ❑ALT. El AD'N. El RPL. 11 MVE.
7
❑ BLD. ❑ PLMB�paECH. ❑ M.H. ❑ POOL ❑JOTHERCertifi.
of Exempt.
Required
Yes❑ No❑
Number
WORK
or Variance 7
Received
Yes El No❑
DESCRIBE W RK
Shorelines/ Flood Hazard
Plans Required ❑
A
8• _A_r � � � � �
Yes❑ Not Applic. ❑
Received ❑
VALUATION I
SOURCE
OF
OF
Qe
ELECTRIC
WATER I SEWAGE
PUBLIC ❑ SEPTIC ❑
Ownership
FEES COLLECTED
9
�/
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 INSPECTIONS
Plumbing
SIGNATURE OFT�y� APPLICATION /
�U 6 "ZZL�u
OWNER OR AGENT �r��v DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
F,,,,;,
Other (Specify)
Utilities
Plans i I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ' Hill IN 180 DAYS
Tech.
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
Lo
C c, C,
07
647?,
DATEWIJEDJ 1— T'N
8 PERMIO. u' 0 z * � U 0 TOTAL
CL
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