1984, 03-22 Permit: 84A-2471 FurnacePLAN NUMBER APPLICAT10 /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
STREET ADDRESS onimmEk
PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNE f PHONE PHONE
3. exp"
MAILING ADDRESS ZIP ua Set ks In Feet to:
North South East West
CONTR CTOR / LICENSE EXP RES PHONE Size of Parcel Zone Classification Residential
4. ( _ Commercial ❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
� D ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation I Total Bldg. Floor Area
5.
ADDRESS
6.
TO
ZIP
�• OF 1�NEW L1 ALT. ❑ AD'N. ❑ RPL. ElMVE. ❑OTHER
Floor I Upper Floors
No. Floors
s/Storage Greenhouse
Fin. Basement Unfin. Basement
D. Fin. Rooms No. Dwellings
PE MIT NUMBER
M/� -7
WORK ❑ BLD. ❑ PL -MB. X MECH. ❑ M.H. ❑ POOL
Cartifi. of Exempt.
Required
Yes❑ No El
or Variance
Received
Yes❑ No[-]
Tmber
DESCRIBE WORK ,
8'
Shorelines/ Flood Hazard
Plans Required ❑
111 E G ftMn
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOUR
GAS
ELECTRIC
WATER
SEWAGE
Ownership
9
I
OF
OF
PUBLIC ❑
SEPTIC ❑
FEES COLLECTED
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 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF> APPLICATION
- � t
OWNER OR AGENT -%' — _ DATE �Z.Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
Fire
MFG. Home
Prevent.
Engineer
Other (Specify)
Utilities
SEPA
TOTAL $ `!;iL4
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS "'' _ / 1 �}
Tech. iJ DATEUi D`' 2 r'RMI?'WO`. '�• z * 2 U. U O 1L AL