1983, 08-23 Permit: 83A-8090 Plumbing FixturesPLAN NUMBER
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. `.� z c due
PARCEL NO.
LOT BLOCK SUBDIVISION
2.
OWNER
3. R A 1.14►zo6►-
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 'South
CQNTRACTOR
ADDRESS
C y 1 t 'T t:A Oro -+1:. Lt4
LICENSE EXPIRES
202,
PHONE
7 ( -%AZ1
Size of Parcel
11 Zone Classification
East
IWest
Residential ❑
Commercial ❑
(174140
SI5e)i 4 -
ZIP
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE KNEW
7. OF
WORK Li]BLD.
ALT. ❑ AD' N. ❑ RPL. 0 MVE.
PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Non
Number
8.
DESCRIBE WORK
.e !-tX-14--2ts
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC D
SEWER ❑
Ownership
Public ❑ Private ❑
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 ca e provisions of any other state or local law regulating construction or the performance
of construction. S - IDE OR REQQUU ED INSPECTIONS
SIGNATURE OFJ APPLICA ION - 2 -34 3
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
l
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 $ 2_.
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ED2 3 - 0 3
PERMIT+ .
9' 0
*29.00AL