1983, 02-14 Permit: 83A-1021 Plumbing FixturesPLAN NUMBER
1
APPLICATION /PERMIT
SPOKANE COUNTY -= BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
JOB ADDRESS / e59
LOT
BLOCK
SUBDIVISION
L� Aru,5.--t/f
LEGAL DESCRIPTION - SEE ATTACHED
OWNER tek3 ri
PHONE
PARCEL NUMBER /S
ADDRESS
ZIP
4.
CONTT CTOR
C. 0740 69.-4 kW* Olt g} 1 c�
P ONE
Actual Set Backs in Feet
North 'South East (West
Size of Parcel
Zone Classification
ADD(2 _:203
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
IR/NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. 11; PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATE R
SEWER
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
1 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 authority to violate or cancel the provisions of any other state or local law regulating.. onstruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildin Technician g�
c.i
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
4
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $`5
PERMIT NUMBER
03* *8500
*85006
A *000
102.0g
02-14-83
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02 14 8'3 10212 *85.00 °'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT NO. 101,\L