1983, 11-15 Permit: 83B-1693 Plumbing FixturesPLAN NUMBER
APPLICATI Q-- N/PERMIT
SPOKANE COUNTY — DEFAR RENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
RO
PARCEL NO.
LOT
2.
BLOCK l SUBDIVISION
vvire
3. G Ke -iii) �r �cv6tcn �
MAILIN ADDRESS
i(% ( eo02 «r-1 /hyj C-1 '
_RACTOR 1 /
4. ESS
.gD x (79o/
5.
DESIGNER
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
LICESErE 9ES
PHONE
.573,/-3 as
ZIP„„:225
Actual Set Backs in Feet to:
Nath 1South [East I West
Size of Parcel
Type Const.
Occupancy
Zone Classification
Residential 0
Commercial 0
Spr nklered
oYer DNo DReq'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
Basement
Basement
TYPE %NEW 0 ALT. 0 AD' N. 0 RPL. O MVE.
7. OF
WORK 0 BLD. XPLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
N
o. Dwellings Unfin.
Certlf 1. of Exempt.
or Variance
Required Yes❑ No❑
Received YesD No❑
Number
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILLIITIES
r
/ X 10._G
GAS 1 ELECTRIC WATER
PUBLIC D
PRIVATE D
Shorelines/Flood Haze d
Yes ❑ Not Applic. D
Plans Required 0
Received 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
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 vl ns of any other state or local law regulating construction or the performance
of construction. SEE REVE E S • E OR RE • ..: ED I�''"$PECTIONS
SIGNATURE OF �, APPLICATION ///� /0`7
OWNER OR AGENT ILtit-i f fX-K�r4'1'� DATE ( 1
SPECIAL APPROVA
PRELIM. FINAL • E
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Pans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/_ // / 6.06 .4Lcr
7 _ DIS keoes4cY
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)
ca
TOTAL $ / 74:Ct9
PERMIT NUMBER
83/3 /10G3
03* *41.00
*41.00
A *0.00 8
169.22.
1;1 —1 5-83
6479.
d
O
C5
W
J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DA1U$UED 5
PERMIT 439..'3'z *1.10.0 .p $TAC