1983, 09-08 Permit: 83A-8783 Plumbing FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
l/ of?? — ,20
LOT
BLOCK
SUBDIVISION
PARCEL NO.
1-1txvst -) e
3.
OWNER
GU O c-F -4'
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 'South
East West
CONTRACTOR
4. ,c „Sew,- /I
AD �% 5
/,-03 C Foe-44-5
f
DESIGNER
5.
LICENSE EXPIRES
474—.23 'Est
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
992/
Type Const.
Occupancy
Sprinklered
❑Yes No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Untin. Basement
TYPE WI NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. WORK ❑ BLD.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes ❑ No❑
Received Yes Li Noll
Number
DESCRIBE WORK
8 rre�
Gr�C2 ,[ F L Ti
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
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 REVER - SI ' FO REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT _.`� DATE 3
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
z( 44j-
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s1v�s
a Tb 3S
cp.W4
a` (✓d
6740.1'2
L wits 64.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
J-4'
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ gc5
PERMIT NUMBER
03* *85.00
*85.00
*0.00
078.2<
09 -08 -83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE I SUE 8 3
PERMIiNZ.8, 3 z
*8 n n