1983, 05-25 Permit: 83A-4475 FurnacePLAN NUMBER
APPLICATION/PERMIT
'SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
TYPE No. Baths No. Floors No. Fin. Rooms No. Dwellings
� OF [� `NEW ❑ALT. ❑ AD'N. ❑RPL. ❑ MVE. ❑OTHER
El❑ BLD. PLMB. C•3 ❑ MECH. M.H. ❑ POOL Certifi. of Exempt. Required Yes L1 No 11 Number
WORK
APPLICANT: COMPLETE NUMBERED SPACES —
PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
Shorelines/Flood Hazard
Plans Required El
PARCEL NO.
Yes El Not Applic. ❑
3
na!
I SOURCE
OF
GAS ELECIfRIC
WATER
PUBLIC ❑
LOT BLOCK SUBDIVISION
Ownership
LEGAL DESCRIPTION:
2.
PRIVATE ❑
SEWER
71 Private EJ
OWNERPHONE
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
PHONE
Building
3
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�� c APPLICATION
MAILING ADDRESS
�/J
OWNER OR AGENT /% ' :Lzzl DATE ✓
ZIP
Actual Set Backs in Feet to:
North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4.
ADDRESS Of
ZIP
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
6.
TYPE No. Baths No. Floors No. Fin. Rooms No. Dwellings
� OF [� `NEW ❑ALT. ❑ AD'N. ❑RPL. ❑ MVE. ❑OTHER
El❑ BLD. PLMB. C•3 ❑ MECH. M.H. ❑ POOL Certifi. of Exempt. Required Yes L1 No 11 Number
WORK
or Variance
Received Yes Ll No❑
DESCRIBE WORKp� �
8• -
Shorelines/Flood Hazard
Plans Required El
!�G
Yes El Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS ELECIfRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC 71public
Ownership
FEES COLLECTED
9
PRIVATE ❑
SEWER
71 Private EJ
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 OF�� c APPLICATION
�/J
OWNER OR AGENT /% ' :Lzzl DATE ✓
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOT
PRELIM. FINAL DATE
Env. Health
Planning
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building C IN 180 DAYS
Tech. l
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $ / y o�
PERMIT NUMBER
04* * 1 4.00
*14006
A *0.00 n
447.44
05-25-83
4 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 4
DATE fSSUED ` G PERMIT NO. z
*1400°
TOTAL
iL
O
U
W
J_
W