1983, 04-22 Permit: 83A-3196 FurnacePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
'
APPLICANT: COMPLETE NUMBERED SPACES —PRESS
HARD TO MAKE 3 COPIES
Fin. Basement
STREETADDRESS
F-0
PARCEL NO.
4o -5
TYPE NEW ❑ ALT. ❑l A�'D' N. ElRPL. El MVE.
No. Baths No.
LOT
BLOCK
SUBDIVISION
7 ❑OTHER
LEGAL DESCRIPTION:
2.
I
Certifi.of Exempt.
Required
OWNER_
Number
PHONE
3.
U
Go
DESCgIBE_W RK
,
Plans Required El8.
Yes❑ Not Applic. ❑
MAILING ADDRESS
VALUATION
9
SOOFCE
ZIP
Actual t Backs in Feet to:
P-t-UBLICO
01 V50111<
1b&082
9 9'%{O �>North
South East West
UTILITIES
CO T A
TOR
AEA
PRIVATE ❑
LICENSE EXPIRES
H N
_ � 7
Size of Parcel
Zone Classification
Residential ❑
4.
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
Commercial ❑
Plumbing
ADDRESS
�j.g
(-
�j''K
OWNER OR AGENT DATE %
P
Type Const.
Occupancy
Sprinklered
❑Yes EI ❑ Req 'd.
PRELIM. FINAL DATE
Ip
Plan Check
21i�
22
� C � f
� �
DESIGNER
HONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
Modular/
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE NEW ❑ ALT. ❑l A�'D' N. ElRPL. El MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7 ❑OTHER
WORK ❑ BLD. ❑ PLMB. Z_'ElM.H. ❑ POOL
Certifi.of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCgIBE_W RK
Shorelines/ Flood Hazard
Plans Required El8.
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9
SOOFCE
GAS
ELECTRIC
P-t-UBLICO
SEWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
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 REVERS IDE FOR REQUIREP.2LSPECTIONS
Plumbing
SIGNATURE OF �C/ APPLICATION
OWNER OR AGENT DATE %
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Ip
Plan Check
Env. Health
� C � f
� �
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Engineer
Other (Specify)
Utilities
TOTAL $
SEPA
•
PERMIT NUMBER
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COPiiMENCED
Building i N 180 DAYS
Tech. 0 4 --2 2 8 3 319, 6 z 18.0 0
2 DATE ISSUED PERMIT NO. TOTAL