1983, 01-06 Permit: 84A-128 Water HeaterPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTME+`T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASH)NGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
2.
3'
— .(C oR l'
LOT BLOCK SUBDIVISION
W n ,
O
PARCEL NO.
At+ K.PJJ
LEGAL DESCRIPTION:
MAILMG ADDRESS
� /S roq
4. CONTPA5
14 LLL
ADDRESS/ f /D CAP
DESIGNERIG
5.
ADDRESS
HONE
-43e3
kik
Ljrf9/ENS.0 EXPIRES
FY
PHONE
P VONE
r afoo
6 (cY- d
Actual Set Backs In Feet to:
North 'South (East I West
Size of Parcel
Type Const.
Occupancy
Zone Classification
Residential 0
Commercial 0
Spr"nklered
DVes 0No OReq'd.
PHONE
New Const. Valuatlon
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
0 ALT. 0 AD' N. 0 RPL. 0 MVE.
0 PLMB. RJv1ECH. 0 M.H. 0 POOL D OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif 1. of Exempt.
cc Variance
Required Yes❑ No0
Received Yes0 No❑
Number
DESCRIBE
8. .!
VALUATION
9.
Shorelines/Flood Hazard
Ves0 Not Apolic.0
Plans Required 0
Received 0
SOC
OFV
UTILITIES
GA$
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 applcation 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 IDE F REOUIRINSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
fl?
1241.4
APPLICATION" 4.7-4,
DATE G y
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)
TOTAL $[
PERMIT NUMBER
314 - 120
03* *16.00
*16006
A *0.00 0
1272
01-06-83
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
��111 ,J, IM i+: LL
DATE ISS0ED O --'8-3' PERMIT NO 2 8 Z *160 O OTOTAL
L