1983, 05-13 Permit: 83A-4023 FurnacePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPAR7MENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1_
2.
3.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
61 / PARCEL NO.
SUBDIVISION
PHONE PHONE
4.
CONT TOR
D
No. Floors
/
No. Dwellings
DESIGNER
5.
ADDRESS
7. ❑OTHER
OF
CHANGE OF USE FROM
6.
Certifi. of Exempt.
TO
ZIP
LICENSE EXPIRES PHONE
ZIP
PHONE
ZIP
PERMIT NUMBER
LLUAL Ut_5GHIt' I IUN:
Actual t Backs In Feet to:
North South East West
Size of Parcel Zone Classification Residential ❑
Commercial ❑
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd. c !J- i n
New Const. Valuation I Remodeled Valuation I Total Blda. Floor Area
Main Floor I Upper
Fin.
Utilities
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building/ 3 IN 180 DAYS
Tech.
TOTAL $ t4'W
WHEN MACHINE VALIDAT
THISBECOMESA PERMIT.
DATE LSS(J�l
PERMIT41W L, 5 z * 141 0 O1oEbiAL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE 'NEW El ALT. El AWN. 11 RPL. ❑ MVE.
7. ❑OTHER
OF
Certifi. of Exempt.
Required yes No❑
Number
WORK ❑ BLD. 13PLMB.eAECH. 1:1M.H. ❑ POOL
or Variance
Received Yes❑ No❑
DESCRIBE W RKj
8
Shorelines/Flood Hazard
Plans Required ❑
-O
Yes Not Applic. ❑
Received ❑
9 VALUATI N
SOOFCE
GAS
EL,ECT�1C
PUB IC VVATE0
SEPTIC SEWAGE
OwnershipFEES
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. T ranting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other stor4ocal law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED~ECTIONS
Plumbing
SIGNATURE OF APPLICATION _
::S5 �3 -�--3
Mach.
OWNER OR AGENT a DATE
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
r
Other (Specify)
Enninaer
Utilities
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building/ 3 IN 180 DAYS
Tech.
TOTAL $ t4'W
WHEN MACHINE VALIDAT
THISBECOMESA PERMIT.
DATE LSS(J�l
PERMIT41W L, 5 z * 141 0 O1oEbiAL