1983, 10-07 Permit: 83B-102 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
-F19 PERMITNUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY 530 •5 gJ IO2'
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
1.Al. ///
✓`
LOT BLOCK
UBDIVISIO
LEGAL DESCRIPTION:
2.
I
O
PHONE
PHONE
3.
-2
MAILING DDRESS
ZIP
Actual Set Backs in Feet to:
inc
North South East
West
CONTRA TOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
�0
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation 7otal
Bldg. Floor Area
J.
ADDRESSZIP
--
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
6.
TO
TYPE
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
NEW ❑ALT. 1:1 AWN. ❑RPL. El MVE.
7 WORK ❑ BLD. XPLMB. ❑ MECH. ❑ M.H. El POOL El OTHER
OF
e_
Certifi. of Exempt. _T
Required Yes El No El
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required L18
Yes❑ Not Applic. ❑
Received ❑
VALUATION SOURCE'
9•
GAS ELECTRIC WATE
ICO SEPTIC O OwnershipOF
FEES COLLECTED
UTILITIES
PRIVATE ❑ SEWER ❑ Public ❑ Private ❑
I hereby certify that I have read
and examined this application and have read the "NOTICE" provisions included on
Ay
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
L
work will be complied with whether
specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
c
of construction. SEER RSE
SIDE FOR OMIRED INSPECTIONS
Plumbing
SIGNATURE OFAPPL���;�„�,�
OWNER ORAGENT
DATEICATION
/�D ' d
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
Fire
(— 77,,_
MFG. Home
>_
Prevent.
f �k—
d
v
Engineer
Other (Specify) ,
,n
W
J
Utilities
l//Oce✓,
LIIC`"�e v-
TOTAL $ �
�_•
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
�
IN 180 DAYS
o JBe
L
LI
DATE"ED�PERMIT N1. fO+A