1983, 12-08 Permit: 83B-2384 Gas PipingPLAN 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. y zv 7
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 f4'a,c - 'pc. (c _ver
4c
MAILING ADDRESS
Sic« --e
HONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
Nath ISouth [East I West
4.
CONTRACT/0?....„
LICENSE EXPIRES
ADDRESS
✓r z
PHONE
7OG
ZIP
99za(
Size of Parcel Zone Classification
Residential 0
Commercial 0
Type Const.
Occupancy
r
Sprinklered
°Yes UNo Req. d.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin Basement
TYPE [ANEW 0 ALT. ❑ SD' N. ❑ RPL. ❑ MVE.
7. OF 0 WORK BLD. 0 PLMB. MECH. ❑ M.H. 0 POOL OTHER
No. Battls
No. Floors
No. Fin Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required YesE NoO
Received Yes❑ No❑
Number
DESCRIBE WORK8.
VALUATION d _SOLURCE ASELECTRIC
9•OF
UTILITIES
Ltd.( C
ea /6"..s
Shorelines/Flood Haza d
Yes° Not Applic. 0
Plans Required O
Received D
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private O
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 cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRE DINBPECTIONS
SIGNATURE OF
OWNER OR AGENT iE
SPECIAL APPROVALS/
PRELIM FINAL ATE
/% Oag--- DATECATION4 p�
Env. Health
Planning
Fire
Prevent.
Engineer,
Utilities
SEPA
Plans
Exam.
Building
Tech.
Z
SPECIAL CONDITIONS: (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 $ (z=
PERMIT NUMBER
._2304=
53062/-
04*
3062/.
04* *12.00
*12.006
A *000 3
23832
'12-08-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATH95UEd 8 - 8 3"
PERMIYNk8. 4 iz*1 2 O O 'clIAL