1983, 06-01 Permit: 83A-4655 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.
STREET ADDRESS
D ?oi A-cpg sle-4
Gf'
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. 0 f-r(-4 dud, l-Nc
fvTAILING ADDRESS
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North I South I East I West
4.
CO TRACTOR LICENSE EXPIRES
.S•r -sue dlre rgom 44.7. '
DRE
A .7ASS �? 6 Fp,z.r�sf
DESIGNER
5. ADDRESS
Size of Parcel
Type Const.
Occupancy
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
EYes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE E -.N.EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. ❑OTHER
7. OF ❑ BLD. Ce.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesE No❑
Received YesE No❑
Number
8. DESCRIBE WORK tIc7)4 76)1 r5
Shorelines /Flood Hazard
YesE Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
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 provision . any other state or local law regulating construction or the performance
of construction. SEE REVERSE D OR R ' UIRED INSPECTIONS
1111.1 I
SIGNATURE OF
OWNER OR AGENT
APPLICATION / /„
DATE CO � r
SPECIAL APPROVALS
PRELIM. FINAL DATE
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDI IONS: (SEE REVERSE SIDE FOR NOTICE)
f¢Q34s,
2 t r't
4 c4764
5tI'i-
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 $
PERMIT NUMBER
SBA
03* *8500
*85.006
A *0.00 8
46542
06-01-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 1531
-,01- 8 3
PERMITSV& 5.5 z
* 8 5.0 0TVAL