1983, 05-25 Permit: 83A-4469 Plumbing FixturesArrLil oR 1 1UN/ h LKnn 1 I PERMITNUMBER
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
,i
STREET ADDRESS PARCEL NO.
2. LOT
I BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
Received ❑
OWNER
PHONE
PHONE
3. 1,0 O (-F( 4P& —
ER
PUBLIC ❑
G❑E
SEPTIC
OwnershipFEES
`
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East West
% -; j
CO RACTOR
B (.0 *- &Vlw-
LICENSE EXPIRES
PHONE
2 y 3 y
Size of Parcel
Zone Classification
Residential El4.
x
y
thority to violate or cancel the provisions of any otherstate or local law regulating construction or thenceof
construction. SEE REVERSE SID REQUIRED INSPECTIONS
Commercial ❑
SIGNATURE OF APPLICATIONOWNER �sMach.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
3 ao X022 t 5
SPECIAL CO ITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
Dyes ❑No ❑Req'd.
Y4 C
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor area
5.
fj SGPS
SEPA
Planning
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6. CHANGE OF USE FROM
TO
Cover Deck
I Uncv. Deck
Fin. Basement
Unf in. Basement
C
n
TYPE 4pIEW El ALT. El AWN. ❑RPL. El MVE.
No. BatFT7
No. Floors
No. Fin. Rooms
No. Dwellings
Prevent.
7.
OF El OTHER
T
WORK ❑ BLD. < PLMB. ElMECH. ElM.H. El POOL
Cert!fi.ofExempt.
,/I,,
��%J
Required
Yes No❑
Number
446,9 *85.901LFj
PERMIT NO. TOTAL
a
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W
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or Variance
Received Yes❑ No❑
DESCRIBE WORK
8. �F�C
Shorelines/ FloodIgive
Plans Required ❑
Yes Not Applic.
Received ❑
VALUATION
9
SOOURCE
GAS
ELECTRIC
ER
PUBLIC ❑
G❑E
SEPTIC
OwnershipFEES
COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisionon
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governine of
work will be complied with whether specified herein or not. The granting of a permit does not presumau-
Building
thority to violate or cancel the provisions of any otherstate or local law regulating construction or thenceof
construction. SEE REVERSE SID REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATIONOWNER �sMach.
OR AGENT DATE
SPECIAL
APPROVALS
SPECIAL CO ITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL DATE
Y4 C
Plan Check
Env. Health
fj SGPS
SEPA
Planning
C
n
Modular/
MFG.Home
Fire
Prevent.
T
,/I,,
��%J
Other (Specify)
Engineer
� Shy
�
�,P,
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
r, r� 5_ 3
DATE IwjS6ED
Building
Tech.
gy
C i
S�
446,9 *85.901LFj
PERMIT NO. TOTAL
a
O
V
W
J_
U_