1983, 10-05 Permit 83A-9968 FurnacePLAN NUMBER
APPLICATION/PERMIT "l 1
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY a/DOJ
i.
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
g A- 2x,0
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
LOT /BLOCK
OWNER
IUBDIVISION " e"Li`if--)/
3,4 / . c(', /F'ci vv
MAILING ADDRESS
CONTRACTOR �— /
4. P� /o�Qd �zr Deaf
ADDRESS
PHONE
7* '
LICENSE EXPIRES
PHONE
ZIP
PHONE
3a6zf5'c'
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North I South
Size of Parcel
Type Const.
Occupancy
[East
West
Zone Classification
Residential 0
Commerclal 0
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unlin. Basement
TYPE 0 NEW gi-ALT. 0 AD'N. 0 RPL. ❑ MVE.
7. OF 0 BLD. 0 PLMB. 0 MECH. 0 M.H.
WORK
❑ POOL ❑ OTHER
No. Baths
No. Floors
No. Fln. Rooms
No. Dwellings
Certif I. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
DESCRIBE WORK
VALUATION
9.
U lcid 07 en,
Shorelines/Flood Hazard
Yes❑ Not Appllo. ❑
Plans Required 0
Received 0
SOURC
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public 0 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
work will he 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 /f
OWNER OR AGEN `g
APPLICATION
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent. •
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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 $ /6 ��
04* *16,00
* 1 6006
A *0,00
9967-
10-05-83
." 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
o win
5 8 '
DATE�SSUEl7 -
PERMIT9N01 8 Z * 16, 0 0 AL
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