1983, 06-01 Permit: 83A-4659 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. E // O/O -(7- A of c. 4
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. woc.. Fci¢do ,�sdc•—
MAILING ADDRESS
PHONE PHONE
C RACTOR
4. C01,40 rote_ C) K..le.-, .tic
Appagas
DESIGNER
5.
ADDRESS
LIC NSE EXPIRES
-
.z? - ty
ZIP
P
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE 4-NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
❑ BLD. {Z9 PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North [South
Size of Parcel
Type Const.
1 1 East 1 West
Zone Classification
Occupancy
New Const. Valuation
Main Floor
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Residential 0
Commercial 0
Sprinklered
DYes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors Garage /Storage
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Required Yes❑ No Number
Received Yes ❑ No
DESCRIBE WORK
8. .2Q F /rC r
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines /Flood Hazard
Yes Not Applic. ❑
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 REVER SID FOR EOUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION 1,,
DATE
SPECIAL CO DITIONS: (SEE REVERSE SIDE FOR NOTICE)
4JG,
2 5 ivwrt
2 Se wee---
2,w6
.2 tu.{94.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
S �A
A
465.88
06 -01 -83
z 6.479.
*85:00
*85.006
*0.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISAEi10 1 - 84)3 PERMITQ C6 5. 9 5
*85.00,,L