1983, 10-31 Permit: 83B-1099 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMrENPOF BUILDING Sc SAFETY
NORTH 611 JEFFERSON /,SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
LOT
2.
4/6/6 b,_rn—ll
BLOCK 1 SUBDIVISION
PARCEL NO.
OWNER QQ
3LING ADDRE
)•
• 12-92-?
ACTOR
II; 6;17
PT!
/
4.
5.
PT, 2t)
DESIGNER
PHONE
9RS- /5w
LICENSE" E75IRFs
PHONE
ZIP_
cicjz/G.
P3� t—OS//
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
East
West
Zone Classification
Residential 0
Commercial 0
Spr'nklered
DYes ONo Diger; rd.
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Dads
Uncv. Deck
Fin Basement
Unfin. Basement
TYPE NEW D ALT. 0 AD' N.
7. OF
WORK 0 BLD. KPLMB. 0 MECH.
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received YesO No❑
Number
8.
DESCRIBE WORK
/D S
iX lc re
VALUATION
9.
SOURCE
OF
UTILITIES
GAS 1 ELECTRIC
Shorelines/Flood Hazard
YesO Not Appllo 0
Plans Requ'red
Received 0
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 whet sp- Hied herein or not. The granting of a permit does not 'presume to give au-
thority to violate or cancel th. "row se} s of any other state or local law regulating construction or the performance
of construction. SEE REVE SE S r • R REQU1fl b INS{tCTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPR
PRELIM. FI
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
o/
APTECATION /2/143
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)'TI�E)
/ -$,'t k
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. Horne
Other (Specify)
TOTAL $
PM1T NU
J_i3MIER °f7
03* *4500
*45.006
A *000
109.8g
10-31-83
2 6479.
>-
C.1 V
W
J
W
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESA PERMIT.
110^31-8'3
DATE ISSUED
1'09.9= *45.008F.
PERMIT NO. TOTAL