1984, 02-28 Permit 84A-1659 FurnacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
E4A- /(‘' 1
tt.ffisamaroP
1.
2.
STREET ADDRESS
LOT BLOCK
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
OWNER
3
MAILING A PRESS
SUBUIVISIUN
CON RACTOR
4.
AESS
DESIGNER
5.
ADDRESS
D
CHANGE OF USE FROM
PHONE
PHONE
ZIP
I4c
P NE
ZIP
TO
TYPE ❑ NEW 0 ALT. 0 AD' N. ❑ RPL. ❑ MVE.
7 OF ❑OTHER
WORK ❑ BLD. ❑ PLMB. [ MECH. 0 M.H. 0 POOL
DESCRIBE WORK
8.
9.
VALUATION
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
F ARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North 'South East l West
Size of Parcel Zone Classification
Type Const.
Occupancy
New Const. Valuation
Main Floor
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Residential 0
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Uncv. Deck
No. Floors
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public 0 Private 0
Garage/Storage
Fin. Basement
No. Fin. Rooms
Total Bldg. Floor Area
Required Yes❑ No❑
Received Yes No❑
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 R 7UIRED INSPECTIONS
SIGNATURE OF APPLICATION/5 _ J14��j/
OWNER OR AGENT DATE r77 5'
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDI
ONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Greenhouse
Unfin. Basement
No. Dwellings
Number
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
04* *20,00
* 20.00r3
A *0,00
165,82
0.2-28-84
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQ ED 8 n PERMIT1U. 5' 9
*20,00iToIAL