1984, 04-02 Permit: 84A-2806 FurnacePLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY A - X06,
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
3 7
LOT
BLOCK
SUBDIVISION
EGAL DESCRIPTION:
2.
'
OWNERP
HONE
PHONE
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
J—'_ ._ -L
North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential❑
4.
S 7_ e_—SF
Commercial ❑
n
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
//
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
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. ElAD' N. ❑RPL. ElMVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7 WORK ❑ BLD. ElPLMB. ElMECH. ElM.H. ❑ POOL El OTHER
OF
' * * 2 0 0 0
Certifi.of Exempt.
Required Yes No❑
Number
or Variance
Received Yes ❑ No ❑
* 2 0 0 0 6'
DESCRIBE W7O0 K
/f
8's
Shorelines/ Flood Hazard
Plans Required ❑
m
A
"�+ !`/A a_� /; %s_ �`, i /
Yes NotApplic. ❑
Received ❑
* C 0 0 00
VALUATION SOURCE
9•
GAS
ELFF IC
PUBLIC O R
I SEPTIC D
ownership
FEES COLLECTED
280520
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
04-02-84
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
6479.
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF�- APPLICATION _
�
OWNER OR AGE ��� - 11.1 DATE �1
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG.Home
Fire
Prevent.
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. I I
� PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS
Tech. //
Building � _
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
DATE`�SSUED' — �' PERMI748. 0. 6 z * 2 0, 0 0 'rill AL
CL
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C.3
W
J_
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