1983, 07-29 Permit: 83A-7155 Plumbing FixturesPLAN NUMBER
2
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
1.
2.
STREET ADDRESS
,/ee cz..,kl/,t1
LOT
BLOCK
SUBDIVISION
PARCEL NO.
Ow\-yER
rL(P pe -r
3.
MAILING ADDRESS
C 9.,/9
• TRACTOR
4. ► L Y�
,t rESS
DESIGNER
5.
ADDRESS
4
PHONE
LICENS E P = Sj
/7[
PHONE
ZIP
929./.6
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South
Size of Parcel
[East
West
Zone Classification
Residential ❑
Commercial ❑
X
PHONE
Type Const.
Occupancy
New Const. Valuation
Sprinklered
❑Yes No ❑Req'd.
Remodeled 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 [ ' NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. PLMB. ❑ MECH. ElM.H. ❑ POOL ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No
Number
DESCRIBE WORK
8. VALUATION
9.
SOURCE
UTILITIES
GAS
X-1GL..%"L5
WATER
PUBLIC 0
PRIVATE 0
ELECTRIC
Shorelines/Flood Hazard
Vest: NotApplic. ❑
Plans Required 0
Received ❑
SEWAGE
SEPTIC 0
SEWER 0
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 o i Ons of any other state or local law regulating construction or the performance
of construction. SEE REVERSES FOR R DIN.$PECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL, TE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CATIONS:
/ / L
DATE
(SEE REVERSE SIDE FOR NOTICE)
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
& — 715
f 17c
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07.29-8)
DATE ISSUED
71.5,5 *45.00
PERMIT NO.
O
a. (-
TOTAL