1983, 01-12 Permit: 83A-0287 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY'`—baUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3•COPIES
JOB ADDRESS
LOT
2.
BLOCK
957 4:9421 a01/4/
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
(J R S C.'oA/6)4
PHONE
PARCEL NUMBER'S
ADDRESS
ZIP
Actual Set Backs in Feet
North 'South
East
(West
CONTRACTOR -21
4. /,7 , c t 3. , lti v+ -t. ,n/
ADDRESS/bad/ r deNy/L//�c✓
DESIGNER /L
5.
PHONE
S/4r 5-39/
Size of Parcel -
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Dyes DNo 0 Req'd.
PHONE
Valuation
Building Area i Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
TYPE
7. OF
WORK
D ALT. 0 AD N.
PLMB. 0 MECH.
D RPL.
❑ M.H.
❑ MVE.
D POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
DESCRIBE WORK
8. Co. -.,pit "Ifcap \awtb ta
(In 11,JV
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
Enum. Dist.
Location (Area)
SEWER
Ownership '
Public D Private 0
USE CODE
I hereby certify that 1 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 authority 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
DATE OF APPLICATION / f Z/ SIGNATURE OF APPLICANT G__5""'
SPECIAL APPROVALS
NAME DATE
Env. Healt
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
•
SEPA Checklist
SPECIAL CONDITIONS:
0
I'`�'
3 _ -�tlCR
. - L�At:1 tC)5
INPvirs
_ ra-y
_ r/err x.60-1
- 64.f'ytd
/2.- t;x'urPE
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
83A - °2S7
,1
03* *5300
*53.006
A *000 ES
28.6
0'1=12-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i
28.72
DATE ISSUED PERMIT NO.
*5'30:0a1-2
TOTAL