1983, 04-19 Permit: 83A-3072 Furnace, PipingNUMBER APPLICATION/PERMIT
SPOKANE COUNTY - 1018PARt MENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
. 0. ZOIC
2. �
LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3.
PERMIT NUMBER
_`�) 21 /�—
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
No. Fin. Rooms
No. Dwellings
North South East West
COtiTRAC OR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
al ❑
Residential
Q G
WORK El BLD. ElB PLM ❑ M.H. ElPOOL
—�
or Variance
Commercial ❑
4.
DESCRIB WORKj
8• `> G�
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
ARESS
ZIP
Type Const.
Occupancy
Sprinklered
�A
UBI
PLC O
SEWAGE
EIE
PC
OwnershipO
❑Yes ❑No ❑Req'd.
]
DESIGNER
H NE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
v 7.
5.
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
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 %� APPLICATION
i
CHANGE OF USE FROM
TO
Cover Deck Uncv. Deck
Fin. Basement
Unfin. Basement
-
6.
SP L CONDITIONS: (SEE REVERSE SI E FOR NOTICE)
PRELIM. FINAL
DATE
(/ �
j�
% �J
TYPE
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
NEW ❑ ALT. ❑ N. El RPL. ❑ MVE.
7 OF ❑OTHER
Certifi. of Exempt.
Required Yes❑ No❑
Number
WORK El BLD. ElB PLM ❑ M.H. ElPOOL
or Variance
Received Yes❑ No❑
DESCRIB WORKj
8• `> G�
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
UBI
PLC O
SEWAGE
EIE
PC
OwnershipO
FEES COLLECTED
9•
I
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
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 %� APPLICATION
i
OWNER OR AGENT c.•c- DATE C �
J/--`--
Mach.
--h--
SPECIAL
APPROVALS
SP L CONDITIONS: (SEE REVERSE SI E FOR NOTICE)
PRELIM. FINAL
DATE
(/ �
j�
% �J
Plan Check
SEPA
Modular/
Env. Health
Planning
MFG. Home
CDCD
Fire
Prevent.
Other (Specify)
U
tl31
Engineer
4
f
tL
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDA""':D IN THIS SPACE,
THIS BECOMES A PERMIT..
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
o 4 �j n 7 7
9 - 8 3 /' z 18, 0 0 0 -j
Tech ing
(
I
DATE fSSUEDl PERMITN7 `