1983, 11-08 Permit: 83B-1417 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT �l
PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY 5-30o 153i> - 1411
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 /
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. /lis lG
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. moi eic i
MAILING ADDRESS
Q
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North ISouth
East
IWest
4.
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential 0
Commercial 0
ADDRESS /
/.PZV /tc //CZ
ZIP
Type Const.
Occupancy
Spr nklered
DYes DNo DAN 'd.
5.
DESIGNER
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 0 NEW 0 ALT. 0 AD' N.
7. OF C BLD. ❑ PLMB. O MECH
WORK
❑ RPL.
❑ M.H
0 MVE.
❑ POOL O OTHER
N0. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesD No❑ Number
Received YesO No❑
8.
9.
DESCRIBE WORK
VALUATION
ax
Shorelines/Flood Hazard
Ym0 Not Apollo. 0
Plans Required ❑
Received 0
SOURCE
UTILITIES
"'GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
Ownership
Public O Private 0
I 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 to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE FOR REQUIRED INSP
SIGNATURE OF
OWNER OR AGEN
APPLICATION
DATEV.7%
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
c9
/8
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
193 0o' X37-&&-7t9,1^c
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 $ 22.
P/
//0/
04* *2200
*22006
A *000
141.62
1.1-08-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
•f
,((�1
�8r ,181 ; : 17 z
DATEllShED'
PERM T'j& �. ,
*2200cid-Ica