1983, 04-23 Permit: 83A-3443 Plumbing FixturesPLAN NUMBER
r.
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.
.b' Pao
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
14i 009 I -A yA,
3 MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North I South East I West
NTRACTOR /,
DDRESS
F20 7 cE t=om rs [L
LICA�SE EXPIRES
'7=.73-'r
PHONE
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. FioorArea
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
7
TYPE IEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. . OF ❑OTHER
WORK ❑ BLD. iiit\PLMB. ❑ MECH. 0 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. fD Fix
Shorelines/Flood Hazard
Yes NotApplic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
Ownership
Public ❑ 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 REVERSE SID F RE • IRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT _ DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDI IONS: (SEE REVERSE SIDE FOR NOTICE)
a --4-51e e -df
t d
( 45�
/ Iia
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
*45 C
* 500
* 0rn
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE I616 2 9 - 8 3
PERMIT qo4 4, 3 z
*45.0AV`