1983, 11-14 Permit: 83B-1581 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTJI FNT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
BLOCK
y ,u.
SUBDIVISION
OWNER
3 c C-) ?"I e4
MAILING ADDRESS
CRACTOR
c
.a
PARCEL NO.
PHONE PHONE
4. ..5£4c- l(4'co(‘v ea.rc, 1F�c
ADDREAS
DESIGNER
5.
ADDRESS
LICENSE EXPIRSS
ZIP
ZIP
6.
CHANGE OF USE FROM
TO
PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South I East I West
Zone Classification
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Residential ❑
Commercial E
Sprinklered
EYes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Cover Deck
Garage/Storage
Uncv. Deck Fin. Basement
7.
TYPE
OF
WORK
�LNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ BLD. A71yPLMB. ❑ MECH. ❑ M.H. E POOL
❑ OTHER
No. Baths
Certifi. of Exempt.
or Variance
No. Floors
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC E
SEWER E
Greenhouse
No. Fin. Rooms
Required YesE NoE
Received Yes❑ No❑
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Hazard
Yes NotApplic.
Ownership
Public ❑ Private ❑
Plans Required ❑
Received G
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 specifie. I -rein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provision of any o -r state or local law regulating construction or the performance
of construction. SEE REVERSE SJQ F. R REQUIRE • INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVAL
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION,Y-
DATE
SPECIAL CONDITIONS: (S E REVERSE SIDE FOR NOTICE)
pL Gtr c
jv�
S -e(
w0
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
Y38-15-/
*61.00 V)
*61,008
*0.00 S
15a02
11-14-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIS9UEb1 4 - 0 3
PERMIT 5. 0 1 z
*61.00 L
4
0
C.3
W
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