1983, 11-01 Permit: 83B-1189 Plumbing FixturesPLAN NUMBER
1
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
STREET ADDRESS
1.
PARCEL NO.
2.
3
LOT
OWNERkk(-o
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
MAILING ADDRESS
- 231d -
PHONE
122 0476"
PHONE
Actual Set Backs in Feet to:
North 1 South l East I West
CCTOt
4. ADDRESS I
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
HONE
ZIP
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE V NEW ❑ ALT. ❑ AD' N. E RPL. ❑ MVE.
7. OFWORK ❑ BLD. I�PLMB. El MECH. E M.H. El POOL
❑ OTHER
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No CReg 'd.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage I Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Veen No❑
Number
DESCRIBE WORK
_-1 )(- J z
Shorelines/Flood Hazard
Yes CI NotApplic. ❑
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private ❑
hereby certify that I have read and examined this appl'cation 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 toViwate or cancel t rovisions of any other state or local law regulating construction or the performance
of construction. SEE REV S SIDE FO EOU D SPECTIONS
SIGNATURE OF G�� APPLICATION /
OWNER 0.9 AGENT (1.>"? APPLICATION
Plans Required LT
Received ❑
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIQ
_
1 tAJ
(SEE REVERSE SIDE FOR NOTICE)
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. Horne
Other (Specify)
TOTAL
1? -
17.
$
PERMIT NUMBER
03* *17.00
*17.006'
i`. * 0,00 tl
118P
1.1 -01 -83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUEDO — 8
PERMIT'NJ. 8. " z * 1 J. O 44AL