1984, 04-04 Permit: 84A-2913 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
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
1 . //ADDRESSb,
LOT ll/BBLLOCCKK SUBDIVISION
2.
PARCEL NO.
PERMIT NUMBER
MA -21/9
OWNER
3 1n//ES Osl-> ''✓
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
C ;p�\COR6 F!s ONE
•
�p 0C3i7
YO" Re./.74-2. ALA- GokitwPHONELI NSE XPIR S
DESIGNER
5.
ADDRESS
Actual Set Backs In Feet to.
North 'South LEast I West
111 Zone Classification
Size of Parcel
Residential 0
Commercial 0
Type Const.
Occupancy
Spr nklered
Oyes 0No OReq. d.
New Const _Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
8.
TO
Cover Deck
Uncv, Deck
Fin. Basement
Unfin Basement
TYPE ®'NEW
7. OF
WORK 0 BLD.
O ALT. 0 AD' N. 0 RPL. 0 MVE.
TWILMB. 0 MECH, 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certih. of Exempt.
or Variance
Required YesO No0
Received YesO No0
Number
8.
DESCRIBE WORK
VALUATION
9.
9 i-x7ti RE
F
SOURCE
UTILITIES
GAS
Shorelines/Flood Hazard
YesO Not Applic.0
Flans Required 0
Received 0
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
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 REVERSE SIDE FOR REQUIRED INSPECTIONS /
SIGNATURE OF / y (1 cX �; `' DATE CATION 21 -
OWNER ORAGENT `.vl+..,J�-�'t� 1 �—i _ ? L
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
&am.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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)
4 co
TOTAL $ >r`-" o -b
//
03* *4600
*46006
A *0.00 8
2912
04-04-84
g 6479.
IL
0
v
W
J
L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESA PERMIT.
DATE15S11E��:1Du f7w 4 "4e�1
—'
PERMIPNO. LL 3 Z
*46UUTOTAL