1983, 03-31 Permit: 83A-2442 Plumbing FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
STREET ADDRESS
1.
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
BLOCK
4,7 /o /Z G Aug Q 7'-4
SUBDIVISION
PARCEL NO.
3
OWNER
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
4TRACTOR
w
4 Ss.�'- k9�N9 vac -�%ui tc
ADDRESS
452 C iQi't fry/
DESIGNER
5.
ADDRESS
ZIP
LICENSE EXPIRES
'f �3 fS.7
PHONE
Actual Set Backs in Feet to:
North I South East West
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
44ZIP
2/
Type Const.
Occupancy
Sprinklered
EYes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
6.
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
7.
8.
9.
TYPE ANEW
OF
WORK ❑ BLD.
DESCRIBE WORK
VALUATION
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
4PLMB. O MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes ID No
Received Yes ❑ Noll
Number
020 &sr_zv�'
i
SOURCE
UTILLIITIES
Shorelines /Flood Hazard
Yes Not Applic. ❑
Plans Required E
Received C
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC E
SEWER ❑
Ownership
Public C 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 prov of any other state or local law regulating construction or the performance
of construction. SEE REVERS S • E FO REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
4111 OIL or ail°.
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION
DATE 3l
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Yi
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
4.5i ri
a Tv
�5 otir�
asp
a,t�
awe•
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 $ �S
PERMIT NUMBER
03* *85.00
*85006
A *000 8
24412
03 -31 -83
2 6:479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
pi
DATE ISSUE
PERMITNO. 4 2 z
*85.° 'CAL
CL
W
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