1983, 04-22 Permit: 83A-3194 FurnacePLAN NUMBER APPL ICAT ION /PERMIT IPERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY`S
r
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET DDRESS
PARCEL NO.
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
6.
1
OWjJER( t �
PHONE
ON —2%"
3.
`
No. earns No.
MAILING ADDRESS
e2lP f
ACtua Set Backs in Feet to:
North South East West
CONRAC R_
LICENSE EXPIRES
P N .
Size of Parcel
Zone Classification
Residential
4.
Commercial ❑
AO SS
��
WORK El BLD. ElBLD. ❑ PLMB. �CH. M.H. 1:1POOL
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
-
lJ
or Variance
DESIGNER
PH NE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
M
Shorelines/ Flood Hazard
Plans Required ❑
ADDRESS
ZIP
Main Floor
Upper Floors
GaragelStorage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
1
`
No. earns No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AWN. El RPL. E] MVE.
7. OF ❑OTHER
WORK El BLD. ElBLD. ❑ PLMB. �CH. M.H. 1:1POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESr,FtIBEWOBK
8.
M
Shorelines/ Flood Hazard
Plans Required ❑
v
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
PUBLICO
SEPTIC D
Ownership
FEES COLLECTED
9
UTILITIES
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 REVERS IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF J APPLICATION
f L`y�
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
I
Pi r,kV �I
Plan Check
Env. Health
l �►:/
or
SEPA
Planning
Modular/
MFG. Home
>_
Fire
Prevent.
a'
O
Engineer
Other (Specify)
v
W
J_
Utilities
IL
(
LL
TOTAL $
SEPA
MACHINE IN THIS SPACE,
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERM TIED
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
IN 180 DAYS
0 4-2 2- 8 3 1 0
DATE ISSUED 9' 4 z
* 1 "' 0 0 0110tTAL
PERMIT (7.