1983, 08-12 Permit: 83A-7732 Plumbing FixturesPLAN NUMBER
APPLICAZOkl/PERMIT
SPOKANE COUNTY —BUILDING CODES DEPARTMENT
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 -COPIES
JOB ADDRESS
1. 4/ /5/J
LO BLOCK SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
3.
OWNER
/71197‘
ADDRESS
PHONE
»'t 6C
/1/,,W /%ro%/a
ZIP
Actual Set Backs in Feet
North 'South East 'West
4.
CONT L.CTOR
,rcr—yo,� 7/e74/77
D S
A7 , /8o r
PHONE
%89Sr
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
' DYes . ❑No 0 Req'd.
5.
DESIGNER
PHONE
Valuation I Building Area 1 Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT. 0 AD N. to—Br�L. 0 MVE.
❑ PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
P g7sel4 ,/X�rts
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
LECT RIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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 authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
I.i —/D 3 SIGNATURE OF APPLICANT
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
/
/--rte,
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building �^
Plumbing r71,40
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL , $ e7l,DO
PERMIT NUMBER
'U ---7%32--
03'* *25.00
*25006
A - *0.00
77312
08=12-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES AP,ERMIT. )8:' -1
'08 12 8,3 7'73'21
*2'..5.110 it'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. - TOTAL