1983, 04-18 Permit: 83A-3020 FurnacePLAN NUMBER APPL (CATION /PERMIT
SPOKANE COUNTY - DEPARTMENT 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.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3.A/
PERMIT NUMBEEJ
v
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
I
CONTRA R.
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4. Z
Commercial ❑
x
AD DR SS
ZIP
Type Const.
Occupancy
Sprinklered
_
"-irz ruc i
❑Yes ❑No ❑Req'd.
J
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
L
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
YPE C�CNEW El ALT. El AD'N. El RPL.
TOF
F-1 MVE.
%.
❑OTHER
Certifi.ofExempt.
Required
Yes❑ No❑
Number
IkEl
WORK BLD. PLMB. KMECH. M. H. POOL
or Variance
Received
Yes❑ No[-]
DESCRIBE WORK
8
j
Shorelines/ Flood Hazard
Plans Required ❑
.,
Yes Not Applic. ❑
Received ❑
VALUATION
S
OF
GAS EL CTRIC
PUBLIC ❑
SEPT C ❑
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 pvisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
a granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any othe
a or local law regulating construction or the performance
of construction. SEE REVERSE SIDEPOR REOUIRAZINSPECTIONS
Plumbing
SIGNATURE OF
-
APPLICATION
DATE � ��
�_
OWNER OR AGENT
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
-
MFG.Home
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building X4 IN 180 DAYS
Tech. 122
Other (Specify) J
19-1
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
DATEYSSUEDI 8
— U / PERMIA9. 2. O z * 19, O O SAL