1983, 07-27 Permit: 83A-7036 Plumbing Fixturesr•LHIV NUMOCM NrrL. nom 1 IV IV / IrGi' M I 1 0(-k I rthlMl I IVUMtSLN
SPOKANE COUNTY — DEP�iTMENT OF BUILDING & SAFETY �3 3c=�;- • 7030 ����
NORTH 811 JEFFERSON / SPOKA•hIE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL N0.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OW RPHONE PHONE
3. MAIUNQ ADD ESS / n n ZIP I Actual t Backs in Feet to:
I n I LICENSE EXPIRES
4.
5.
ADDRESS
North South East I West
P ONE�� Size of Parcel Zone Classification Residential❑
Commercial ❑
ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
ZIP III Main Floor I Upper Floors I Garage/ Storage I Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
I Fin. Basement
Unfin. Basement
.,i•�o
6.
Engineer
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW 1:1ALT. ❑ AD' N. 11RPL. 1:1MVE.
7.OF El OTHER
SEPA
Certifi. of Exempt.
Required Yes El No❑
Number
WORK ❑ BLD. PLMB. ❑ MECH. ❑ M.H. 11 POOL
Plans
Or Variance
Received Yes❑ Nc❑
Exam.
DESCRIBE W R
Shorelines/ Flood Hazard
Plans Required 1:18
Building
Tech.
Yes Ll Not Applic. ❑
Received ❑
180 DAYS
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC 1-1SEPTIC
I SEWAGE
11FEES
Ownership
COLLECTED
9 UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private ❑
1 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 SIDE FQB REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CON IONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning •��+
Building
ly
y�
�1•
Fire
Prevent.
.,i•�o
Engineer
Utilities
�— ^� •
SEPA
PERMIT IS NONTRANSFERABLE
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
71,IN
180 DAYS
Building
ly
y�
Plumbing_
t/ �O
.,i•�o
Mach
Plan Check
SEPA
Modular/
MFG. Home
4G
Other (Specify)
/ Ot+
TOTAL $ /
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUE 7 — PERMITr7
N8. 3, 6 z
*6 1.0 0 JOAL
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