1983, 09-08 Permit: 83A-8749 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS /
'7/7 C•eki kl;
LOT
BLOCK
SUBDIVISION
PARCEL NO.
LEGAL DESCRIPTION:
3.
OWN
Fark. Er,
AILING AD RESS
PHONE
99/
PHONE
Actual Set Backs in Feet to:
•
CQMRACTOR ./
4. tl e --t" likbi,1
Essw,,x ,Q1/
5.
DESIGNER
LICENSE EV.p,
/
North
Size of Parcel
South
East West
Zone Classification
PHONE
Type Const,
Occupancy
Residential
Commercial El
Spr nklered
[Nes ClNo Req ' d.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin, Basement
TYPE EW D ALT. El AD' N. 17 RPL. fl MVE.
7. OF0 OTHER
BLD. LMB, 0 MECH. M.H. 0 POOL
WORK
No. Baths
No, Floors
No. Fin. Rooms
Unf in. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes 0, NoD
Received Yes D No El
Number
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
Yes 0 NotApplic.0
Plans Required 0
Received C
WATER
PUBLIC 0
PRIVATE E
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 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 constructiLl. SEE REVERS ID FOR REQUIRED I SPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPRtAL
PRELIM. FIN L DATE
Env. Health
Planning
Fire
Prevent,
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NO ICE)
P7rc2
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 $ kr-4‹17
PERMIT NUMBER
e-7 —674—or
_
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
9 0 8 UJ
-
DATE ISSUED
7 4 9 5
PERMIT NO.
*4 5. 0 0 Lci).j.j'AL