1983, 07-26 Permit: 83A-6980 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMEW OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
x_11917 P t N
LOT BLOCK SUBDIVISION
2.
OWNER 4Lk i f t
3 �D 3 `i�"'i
MAILINGi "I I$�
CONTRACTOR
a.
PARCEL NO.
PHONE
P
PH E
PHONE
LICENSE EXPIRES
LEGAL DESCRIPTION:
Actual Set Backs in Feet to'
North ISouth lel I West
Zone Classification
Size of Parcel
Residential 0
Commercial 0
ADDRESS
ZIP
Type Const
Occupancy
Sp 'nklered
❑Yes ONo OReq'd.
5.
6.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
CHANGE OF USE FROM
ZIP
Man Floor
Upper Floors
Garage/Storage
Greenhouse
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 2("N/EW ❑SALT. ❑ AD' N. 0 RPL. ❑ MVE.
7. OF ❑ BLD. $LMB. 0 MECH. 0 M.H. 0 POOL
WORK
0 OTHER
No. Baths
No. Floors
No. Fln. Rooms
No. Dwellings
Certlf1. of Exempt
or Variance
Required Yes❑ No
Received YesO No❑
Number
6 DESCR�E FR*
Shorelines/ Flood Hazard
Test: Not Aeolic.❑
Pans Req ired 0
Received 0
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER 0
Ownership
9.
•
Public 0 Private 0
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 R ERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT -.p .— DATE (' aG -83
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health Pi
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
INqfy�G'zan&a-
1
a
�—
1Jr
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 $ r
PERMIT NUMBER
03A ' (0280
03* *17.0.0
*17.008
-A *GOO 8
697.92
07-26-83
2 6479.
0-
0-
Li -
WHEN
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8 3
i
DATE -Map'
PERMITA 8. Q'Z * 17.0 0 Ream.