1983, 12-15 Permit 83B-2543 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
STREET ADDRESS
`
1. '. or'/e
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. .7,
MAILI ADDRESS
/i/ 7
ORACTOfj
4. 74--a' ,in ii
AD SS
//e,/H ✓ �Z%>?
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE /
LICENSE EXPIRES
a-l-f'3
P •N
ZIP
L 7
PHONE
ode
ZIP
PHONE
ZIP
TO
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB ECH. D M.H. ❑ POOL
DESc RI BE WORK
•
VALUATION
9.
SOURCE
F
UTI LLIITI ES
)•P
ELECTRIC
WAJ R
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER ❑
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
Type Const. l Occupancy
New Const. Valuation
'Main Floor
East
West
Zone Classification
Residential ❑
Commercial 0
Sprinklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Upper Floors
Cover Deck
No. Baths
Uncv. Deck
Total Bldg. Floor Area
Garage/Storage
No. Floors
Certifi. of Exempt.
or Variance
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yes❑ No❑
Received Yes 0 No❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT ; a-622 DATE /.2//'3%
73
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
0
Other (Specify)
TOTAL
aa0
PERMIT NUMBER
0313- 2.43
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISLED1 5
2�43z *18.00aF
PERMIT N . TOTAL