1983, 04-22 Permit: 83A-3175 Plumbing FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
1.
STREET ADDRESS
LOT
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
LOCK
1
Jts4 0V
SUBDIVI N
2. 1; - �►� - "(0 VAZAZAL.E%
3 'DIvriEE;141JJ isKI0Or id
MAIiLNG ADDRESS
4. CT: MI6
ADDRESS
DESIGNER
5.
ADDRESS
6.
PHONE
LICENSE EXPIRES
PHONE EEC
597_1
`PARCEL NO.
LEGAL DESCRIPTION:
PHONE
ZIP
Actual Set Backs in Feet to:
North I South East 1 West
Size of Parcel Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
TO
Cover Deck
Uncv. Deck
Fin. Basement
TYPE VNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. J PLMB. El MECH. ❑ M.H. El POOL
DESCRIBE WORK
8.
x,-r Ia
VALUATION SOURCE GAS
9' OF
UTILITIES
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes No El
Received Yes No
Number
Shorelines /Flood Hazard
Yes Not Apollo. ❑
Plans Required ❑
Received ❑
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 include-
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 REVERSEVDE FOR REO ED INSPECTIONS
SIGNATURE OF
OWNER OR AG
SPECIAL APPROVAL�S,7
PRELIM. FINAL /6 ATE
Env. Health
APPLICATION
DATE
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
I e/
1 Y i
11 t �—
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 $
1
!-7
c
PERMIT NUMBER
03* * 1 7.00
31 7.42
04 -22 -83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
o
DATE ISSUEIT 2 — 0 3
PERMIT O.7 5 5 ft 17, 0 0 JYQAL
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