1983, 05-25 Permit: 83A-4467 Plumbing FixturesPLAN NUMBER APPLICATION /PERMIT PERMIT NUMBER
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
STREETADDRESS PARCEL NO.
170-5,077
1 wel e -F ,-Amo"
MAILING ADDRESS
PHONE PHONE
ZIP
North I South I East I West
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 SID EOUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
e�oe
SPECIAL CONDITIONS: (SEE R
C?
a ti� s till,
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. Q—)')
Building
CO RACTORLICSE
Plumbing
EXPIRES
PHONE
Size of Parcel
No. Fin. Rooms
Zone Classification
Residential ❑
❑ ALT. ❑ AWN. ❑ RPL.
O� S A�
td
'` (CEN'
`g'/
L'
q..7 � 7i�
MFG.Home
7. OF
Commercial ❑
4'
£�•
-
TOTAL $
WORK El BLD.
9QPLMB. ElMECH. ElM.H.
El POOL
Certifi. of Exempt.
ADDRESS
�^
5
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
or Variance
3 0203
[—z�fr
DESCRIBE WORK
8
Shorelines/ Flood Hazard
DESIGNER
Plans Required ❑
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Received ❑
VALUATION
SOURCE
of
GAS
ELECTRIC
WATERSEWAGE
PUBLIC ❑
SEPTIC ❑
Ownership
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement Unfin. Basement
6.
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 SID EOUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
e�oe
SPECIAL CONDITIONS: (SEE R
C?
a ti� s till,
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. Q—)')
Building
Plumbing
No. Baths
No. Floors
�"
No. Fin. Rooms
No. Dwellings
TYPE $.SEW
❑ ALT. ❑ AWN. ❑ RPL.
❑ MVE.
Modular/
MFG.Home
7. OF
El OTHER
TOTAL $
WORK El BLD.
9QPLMB. ElMECH. ElM.H.
El POOL
Certifi. of Exempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No 171
DESCRIBE WORK
8
Shorelines/ Flood Hazard
Plans Required ❑
r.cv �7i�
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
of
GAS
ELECTRIC
WATERSEWAGE
PUBLIC ❑
SEPTIC ❑
Ownership
FEES 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 SID EOUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
e�oe
SPECIAL CONDITIONS: (SEE R
C?
a ti� s till,
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. Q—)')
Building
Plumbing
�
¢
�"
Mech.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
DATE 159UED2 5 - 8 3
PERMIT TYt7! 5 * 5. O O *+AL
CIL.
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