1983, 06-01 Permit: 83A-4657 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
1.
2.
3
STREET ADDRESS
// 0/y /& c.,4. 4
PARCEL NO.
LOT
BLOCK
SUBDIVISION
OWNER /'`F.t. �o,
4—R) e.—
PHONE
MAILING ADDRESS
4.
C TOR
oNTRACu7 Tsig 4 reftcm,4„'(cise7.,pic-
LICENSE EXPIRES
y —,73. 9'1
PHONE
ZIP
P ONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South [East ' West
Zone Classification
Size of Parcel
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
ZIP
•t4.7P.0
PHONE
ZIP
TO
TYPE VIEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. < PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
Type Const.
Occupancy
New Const. Valuation
Residential ❑
Commercial ❑
Sprinklered
❑Yes ONo ❑Req'd.
Remodeled Valuation
Main Floor
Cover Deck
No. Baths
Upper Floors
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Fin. Basement
Greenhouse
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes ❑ No
Received Yes No
Number
DESCRIBE WORK
8 ^D Fn(-r 7 J
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines /Flood Hazard
YesE 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 provisio of any other state or local law regulating construction or the performance
of construction. SEE REVERS D' FOR ' EOUIRE II SPECTIONS
SIGNATURE OF 41111-
Wrillar APPLICATION����s� OWNER OR AGENT A — DATE
SPECIAL APPROVALS SPECIAL C
PRELIM. FINAL DATE
Env. Ilea! th
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
g•°`
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
P3A 457
03* *8500
*85.006
A *0.00 8
465.62
06 -01 -83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
7ATEWstfueb0 1 8 3
PERMIT4If6 5. 7 z° * 8 5. 0 0 10 L