1983, 04-19 Permit: 83A-3052 Plumbing FixturesPLAN NUMBER
APPLICA ;ON/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.
1/3/5 �= • ��CG�
LOT
2.
BLOCK
SUBDIVISION
OWNER 11//
Nt S14- t 4 y 4' Ce3 S
3.
MAILING ADDRESS
PHONE
CQNTRACTOR
4. 04� '6C09 -t.. -/e .gNvte4c�
DRESS
/ 3 E face
LICENSE EXPIRES
PHONE
ZIP
P .X3s/..z
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
East I West
Size of Parcel
Zone Classification
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE R9-ALEW ❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
WORK ❑ BLD. PLM B. ❑ MECH. .71M.H. E POOL
Type Const. Occupancy
New Const. Valuation
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Residential E
Commercial E
Spr'nklered
❑Yes ENo ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Garage/Storage
No. Floors
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
UTILITIES
1 if
e rj{
GAS
ELECTRIC
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No❑
Received Yes No❑
Shorelines/Flood Hazard
Yes Not Applic. ❑
WATER
PUBLIC E
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private ❑
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 o other state or local law regulating construction or the performance
of construction. SEE REVERSE SLFO REOU - ED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION .J
DATE '7
Unfin. Basement
No. Dwellings
Number
Plans Required E
Received
SPECIAL APPROVALS SPECIAL CONDITI • NS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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 $
PERMIT NUMBER
03* *45.00
*45006'
A *000
3051
04-19-83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
04-19-83 305,2 z *45,00a�
DATE ISSUED PERMIT NO. TOTAL