1983, 09-12 Permit: 83A-8884 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.
LOT
2.
BLOCK
OWNER
3
MAILING ADDR -;:S
// O/3 —f7 !Qv v5 f4
SUBDIVISION
CO ACTO
ADDRESS
/3.203 I- ‘c-u-0e-/-
PHONE
LICENSE EXPIRES
*2,3 -Sy
PHONE
ZIP
ZIP�P(5.
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
[East
West
Size of Parcel
Type Const.
Occupancy
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE IEW ❑ ALT. El AD' N. El RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. PLMB. El MECH. 171 M.H. El POOL
New Const. Valuation
Main Floor
No. Baths
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Upper Floors
Uncv. Deck
No. Floors
Garage /Storage
Greenhouse
Fin. Basement
No. Fin
Rooms
Unfin. Basement
No. Dwellings
DESCRIBE WORK
8. •( .
ho 76 ` 5)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Certifi. of Exempt.
or Variance
Required YesE No
Received Yes ❑ No f7
Shorelines/ Flood Hazard
YesE Not Applic. ❑
Ownership
Public O 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 REVE SI R REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION Ir /� ,j'3
DATF
Number
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL ONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN180DAYS 9r" • p 3
DATEfSSUED1
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 5 c
PERMIT NUMBER
e3 A -
03* *8500
*85006
A *000
888,32
09 -12 -83
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMITU 8. 4 z * 8 5. O O;Oj -AL