1983, 01-07 Permit 83A-0146 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT
1� L22 c A
BLOCK SUBDIVISION
3
OWNER
ADDRESS
sikmv
4. COAT I
ADD ES
DESIGNER
FJ. ADDRESS
CHANGE OF USE FROM
6. tDIL_
TO
HAIP
1311
ZIP
2R-16a
t,2 7
PHONE
ZIP
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N. , RPL.
I73.MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South East (West
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE WORK
LC LACt �I
VALUATION SOURCE
OF
9. UTILITIES
GAS
47(
Enum. Dist. I Location (Area)
ELECTRIC WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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 authority 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 INSPECTIO
DATE OF APPLICATION I2--10 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
zl`- I" c. pfe.
1 Z ei
Bc cv 6 i 1A . C-
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ I
04* *18.00
* 1 E006
A *0.00 0
14.5g
0'1 -07-83
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
uildin• lechniaian
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0: 07'- '1' 1465 *18,0.0
DATE ISSUED
PERMIT NO. TOTAL