1984, 03-21 Permit: 84A-2436 Plumbing FixturesPLAN NUMBER
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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 9 2 LL % J/
4 Z
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
4�ItG7 C'LQiTv ( C...Z. lG 4% Ca)
PHONE
PARCEL NUMBER/S
ADDRESS
ZIP
4.
5.
CONTR
CTOR%�J��� �,�'�
IIL4,2€: ./ f�C..C.. 4+
A ORfSS
. 'OS &3 .Uta
DESIGNER
PHONE
Actual Set Backs in Feet
North 'South [East IWest
Size of Parcel
Zone Classification
ZIP
4' yo .3 7
Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW tgl ALT. AD'N. 0 RPL. ❑ MVE.
❑ BLD. pif PLMB. 0 MECH. 0 M.H. 0 POOL
0 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.
J p
ELECTRIC
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
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 authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
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SIGNATURE OF APPLICAN4yT^�
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
•
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
( f lldi ech njCid r' V
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PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
g4-; - z'
03* *62,00
*62006
A *0.00 8
24352
03-21-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O2=21—'8,4
2456= *62.80° -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE -DATE ISSUED PERMIT NO. TOTAL
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