1984, 01-09 Permit App 84A-174 Gas FurnacePLAN NUMBER
APPLICATION/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
2.
3.
4.
STRESS
0
LOT
ON�ii
BLOCK
6 it'yll)� }
SUBDIVISION
/ 2 J1C/ 4/ 0 E
M •�rl G�D S
7*- -0--ee7-/-)0(2-7t).Rd
Ti
ADDRE
'G
11,
LIc,99
DESIGNER
ADDRESS
• CHANGE OF USE FROM
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North 'South [East I West
15r;E" / Size of Parcel
ZI➢
PHONE
ZIP
TYPE ❑ NEW ❑ ALT. 0 AD'N. ,RPL. ❑ MVE.
7 oF WORK 0 BLD. 0 PLMB..SMECH. ❑ M.H. ❑ POOL ❑OTHER
D SC IBE WORK
Type Const.
Occupancy
New Const. Valuation
Main Floor
Zone Classification
Residential 0
Commercial 0
Spr nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Upper Floors Garage/Storage
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Certlfi. of Exempt. Required
or Variance Received
V LUATIOQFjp'i
9. `� j±� 7°
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER 0
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public 0 Private 0
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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REV • S SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICAT
DATE
r(i a.-701 9'
SPE AL CONDITIONS: (SEE REVERSE SIDE FOR NOTItkE
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Total Bldg. Floor Area
Fin. Basement
Greenhouse
No. Fin. Rooms
Yes❑
Yes ❑
No ❑
Nof1
Unfin. Basement
No. Dwellings
Number
Plans Requ red ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular!
MFG. Home
Other (Specify) A r
TOTAL $ / ' - 00
PERMIT
P;; 2 IA
04* * 1 9,00
17.32
01 —09-84
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 1 — 0 9 - 8 6 17,49. 0
DATE ISSUED
PERMIT NO.
*19,00 a1-'
TOTAL