1983, 07-15 Permit: 83A-6551 FurnacePLAN NUMBER APPLIICATION/ 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 PARCEL NO.
1. li ._ //Q/O 3 7 --
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER� ✓��A �r PHONE PHONE
MAILING ADDRESS
4.
ADDRESSi
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
ZIP
Actual Set Backs In feet 10:
North South East West
PHONE
Size of Parcel
Zone Classification 7Residential❑
❑ OTHER
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
1;1? %
WORK
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Yes[] Not Applic. ❑
Cover Deck
I Uncv. Deck
Fin. Basement
I Unfin. Basemi
No. Baths I No. Floors I No. Fin. Rooms I No.
TYPE n NEW ❑ ALT. ❑ AD'N. ❑ RPL.
❑ MVE.
7• OF
❑ OTHER
❑ BLD. ❑ PLMB. Xl MECH. ❑ M.H.
❑ POOL
Certifi. of Exempt. Required
Yes[] No[-]
Number
WORK
or Variance
Received
Yes LJ No[]
DESCRIBE WORKc
Shorelines/Flood Hazard
Plans Required El
�/
8• ` ; C�k�e—
Yes[] Not Applic. ❑
Received ❑
VALUATION
SOURCEGAS
OF
LECTRIC
WATER
PUBLIC 1-1
SEWAGE
SEPTICEl
Ownership
FEES COLLECTED
9• 1 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 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-_ j j rd
OWNER OR AGENT �r� DATE / / %�� Mech. 171
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
SEPA
Planning Modular/
MFG. Home
Fire
Prevent.
Fnninm, Other (Specify)
Utilities I I I I
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
TOTAL $/
PERMIT NUMBER
U4* *14,00
* 1 4.006
A *0.00 00
655.02
07-15-33
z 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07x-15-83 655.12 *1400°
DATE ISSUED PERMIT NO. TOTAL
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