1983, 12-05 Permit 83B-2254 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. E__i //7a3 i /E',v1 .
LOT
2.
BLOCK
OWNER
3.
MAILING ADDRESS
CONTRACTOR
4. ADDRESS,
DESIGNER
SUBDIVISION
PHONE
LICENSE EXPIRES
/a.- -
ONl Ol0?e/c'V
PHONE
PHONE
ADDRESS
CHANGE OF USE FROM
ZIP
TO
TYPE O NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF WORK ❑ BLD. ❑ PLMB. �MECH. ❑ M.H. ❑ POOL ID OTHER
DESCRIBE WORK
8• Ns TqL von e re,/ e-0/,.67h.RAl l//?Ni9 G /
VALUATION
9.
SOURCE
UTILITIES
G
ELECTRIC
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet 1o:
North ,South [East `West
Size of Parcel
Type Const. Occupancy
NewConst. Valuation
Main Floor
Zone Classif icatlon
Residential
• i
Spr nklered
OYes ONo OReq'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Total Bldg. Floor Area
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Shorelines/Flood Hazard
"ti 7 Yes NotApplic. 0
WATER / SEWAGE
PUBLIC 0 SEPTIC ❑
PRIVATE ❑ SEWER O
Ownership
Public ❑ Private 0
INo. Fin. Rooms
Greenhouse
IFln. Basement Unfin. Basement
No. Dwellings
Required Yes❑ No0
Received Yes El No0
Plans Required 0
Received 0
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 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
OWNER OR AGENT
APPLICATION
DATE
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
Number
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04* * 1 8.0
*18.006
25,3
*0.0�j
12-05-8`,a
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12--05-83 2254z *11,0
DATE ISSUED
PERMIT NO.
a
TO AL