1983, 02-23 Permit 83A-967 FurnacePLAN NUMBER
APPLI' ITION/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
1.
2.
3.
4.
5.
JOB ADDRESS
,C ,/ 2 2 .L3n 1f 17,i/,s /
LOT SUBDIVISION
BLOCK
OWNER
L , ,k ,4 T/// I/ZA"yLLI 7-7—
ADDRESS
.s1 2-2 Z /i9 .?J /V,4/
CONTRACTOR
A/i✓r,2ir'n/XtC,4 , -2,1 /A/
//lESS z ,8i✓ " 23,
( 54 3 `7/6
DESIGNER
PHONE
ZIP
97-2‘7z
PHONE
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
East (West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation 1 Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors i Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
0 BLD.
0 ALT.
❑ PLMB.
❑ AD'N. I RPL_ ❑ MVE.
IMECH, ❑ M.H. 0 POOL
❑ OTHER
YDESCRIBE WORK
8. & f'/QC-/L f'//di✓, J :A//✓c2 e/2 /45
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
ILocation (Area)
Zwnership
Public ❑ Private ❑
USE CODE
Req'd.
I hereby certify that 1 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 INSPECTIONS
DATE OF APPLICATION 2 - 7- .3 SIGNATURE OF APPLICA
SPEC APPROVALS
NAME DATE
Env, Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Rec'd.
Not Req'd.
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /7„9
PERMIT UMBER
04* *1700
* 1 7,006
A *0.00
96.62
02-10-83
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ilding Tjchpiclan
PERMIT IS NONTRANSFERABLE
02-10-83
96,7z
*17,OOa-
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL