1983, 09-12 Permit: 83A-8882 Plumbing FixturesPLAN 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.
/ /oo 9 -// 4,4usi4 Cf
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 1'-
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North I South 1 East I West
C NTRACTOR
e-
4.
�a� Sf4
LICENSE EXPIRES
4rc,4 gdrc- .f ;
PHONE
Size of Parcel I Zone Classification
Residential ❑
Commercial ❑
ADDS
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
ZIP
PHONE
ZIP
TO
TYPE g-NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
WORK ❑ BLD. ❑ MECH. ❑ M.H. ❑ POOL
Type Const.
Occupancy
New Const. Valuation
Sprinklered
❑Yes 17 No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage /Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes No❑
Received Yes❑ No❑
Number
DESCRIBE WORK
8.
VALUATION
9.
r f'
oho F'(z-n -)
Shorelines/ Flood Hazard
Yes❑ Not Applic. ❑
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ 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 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 REQUIRE TIONS
SIGNATURE OF �s APPLICATI
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plans Required ❑
Received ❑
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
4J C
c22,
( UDC
S c 7
F)
cCi4514
Savt
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 $
PERMIT NUMBER
8
J3* *8500
*85.00,5
A *000 e
88812.
09 -12 -83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE9S UED1 2 - 8
PERMITtNS. 8. 2 5
*85,0 fo ►L