1984, 01-10 Permit: 84A-251 Plumbing FixturesPLAN NUMBER
APPL ICAT IQN /PERM IT
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
1.
STREET ADDRESS
�.4. le(
PARCEL NO.
2.
3
LOT
BLOCK
SUBDIVISION
�
OWNER
n
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North [South [East I West
4.
C NTRACTOR
t l!_1<
LICENSE EXPIRES
PHONE
Cq�- '. %
Size of Parcel 1 Zone Classification
Residential ❑
Commercial 0
ADDRESS
u s 15 f—Q i�2 C.14 -
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE @'TVEW ❑ T. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF ❑ OTHER
WORK ❑ BLD. t3PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes No❑
Received Yes No❑
Number
DESCRIBE WORK
8. to. F't K-t-<--tz t-
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required 0
Received 0
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
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 provisions of any other state or local law regulating construction or the performance
of construction. SEE REV RSE SIDE FOR • E •_ IRE ► I 'La? TIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
glY
APPLICATION
DATE
SPECIAL CONDI % : (SEE REVERSE SIDE FOR NOTICE)
"aTCs I.
ZL L)'
IGtT S: lit K
1 0•t'',Pe-
Jai
t -i —0 4712. --
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building �t r
Plumbing r4;,
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $.
PERMIT NUMBER
FII F Cf1PY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE155UED1 8 4PERMIT N. 5° z
1
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