1984, 03-29 Permit 84A-2700 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
1.
2.
STREET ADDRESS
LOT
PARCEL NO.
r,
BLOCK
SUBDIVISION
4.
5.
OWNER /
It
MAILING ADDRESS _ ? / -
3rzF�l tea l'
CONTRACTOR /,;
ADDRESS
,r•G•it) • . -7 7
DESIGNER
PHONE
'/2 '—
LICENSE EXPIRES;
PHONE
ZIP_ ,
L Cj�C7/
PHONE,.
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 1South 'East I West
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Zone Classification
Residential ❑
Commercial 0
Spr'nklered
❑Yes ❑No OReq'd.
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW
7. OF
WORK ❑ BLD.
8.
9.
DE ..'RIBE WORK
VALUATION
0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
❑ PLMB. y MECH. ❑ M.H. 0 POOL
SOURCE
F
UTILLIITIES
GAS 1 ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
0 OTHER
SEWAGE
SEPTIC 0
SEWER 0
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
Shorelines/Flood Hazard Plans Required 0
Yes CI NotApplic. 0 Received 0
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION i, ¢
OWNER OR AGENT �,',_�.�r7 �� %c Lt S' _ DATE `� —O
SPECIAL APPROVALS SPECIAL CONbITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
401:1
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ -COt
PERMIT NUMBER
04* *20.00
*20006
A *0.00 s3
269.9r'
06-29-64
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES��A PERMIT.
DATEYSSUEC 9 — 8 4. PERMI7403. a a z
*20.00&AL