1986, 08-15 Permit App: 00012750 Mechanical 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
STREET ADDRESS PARCEL NO.
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWWR_ j PHONE PHONE
3. � �
PERMIT NUMBER
,7®
SPECIAL
MA,N ADDR>=SS /jjj
��
Zip
Actual Set Backs in Feet to:
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
North South East
West
DATE
PONTRArTOR
LICE
'
PHONE
Size of Parcel
Zone Classi fication
omOResidential
rciial
4.
-
SEPA
ADDRESS l /� ,
�/7! l�
ZIP
�%�2�'
Type Const.
Occupancy
Sprinklered
Modular/
MFG. Home
ri �' r, !✓
Fire
❑Yes LJ No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Other (Specify)
O
V
Engineer
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE '� NEW El ALT. ❑ AD' N. El RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
%.
WORK ❑ BLD. ❑ PLMB.kMECH. ❑ M.H. ❑ POOL 11 OTHER
Certifi.ofExempt.
Required
Yes LJ No❑
Number
SEPA ,
or Variance
Received
Yes 71 No❑
�
�T
DESCRIBE W RK _Z A,, 1: f -�%� r: lig =L-� Pi 1 cL S
/ � � r �
Shorelines/ Flood Hazard
Plans Required ❑
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
e -�
Yes ❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWAGE
Ownership
9
j_
PUBLIC ❑
SEPTIC ❑
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
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 resume to
P P 9 9 P P give au-
Building
thority to violate or ca the provisions of any of r state or local law regulating construction or the performance
of construction. SEE EVE DE D INSPECTIONS
Plumbing
SIGNATURE OF / r APPLICATION �i
OWNER OR AGENT - DATE 1
Mech.
PERMIT NUMBER
,7®
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL
DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Other (Specify)
O
V
Engineer
W
�
J
li
Utilities
TOTAL $
SEPA ,
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Pians
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building
Tech.
DATE ISSUED PERMIT NO. TOTAL