1983, 07-05 Permit: 83A-6124 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHFNGTON 99260 / (509) 456 -3675 S30 0 `�
PERMIT NUMBER
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
L.)cz lo t.l.
LOT BLOCK SUBDIVISION
OWNER
3. ,
MAILING ADDR SS
? ii 4 u4.10v∎
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
CONTRACTOR J r)
4. l(C /t t v I c (t,' d i`tc'cta'
ADDRESS
z '/ /i� 4.
DESIGNER
5.
LICENSE EXPIRES
ZIP
PHONE
Actual Set Backs in Feet to:
North I South I East I West
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
r;1 2-C)
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
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW $LT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. ,`I PLMB. ❑ MECH. ❑ M.H. CI POOL ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ Noll
Number
DECRIBE WOR
8. t../11
VALUATION
9.
)e uaes
Shorelines /Flood Hazard
Yes NotApplic. ❑
Plans Required ❑
Received ❑
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 provisions of any other state or local law regulating construction or the performance
of construction. SEE ;,A-,. -SE SIDE ■:. _WIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
AlW1111.' 0,"
-_
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
3 --T
3 – U
- S Lc)
/— �sl�
1 17.1-44L
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
i/
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
vie L-r'
Other (Specify) 9
c��7CJ
TOTAL $ -�—
A CcAaci-
03* *49.00
*49,006
A *000
619.8
07 -25 -83
2 6479,
O
C2
W
—J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 117E67 0 5 - 8 3 PERMIT 14.1 2; 4 5
*49.0 4