1984, 04-04 Permit: 84A-2938 Plumbing FixturesPLAN NUMBER APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 992601(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES -- PRESS HARD TO MAKE 3 COPIES
STREET ADDRESSP4,RCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
PHONE PHONE
MPMAM
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
CO TRACTO t
1 N VU (o
LICENSE EXPIRES
P ONE
o —�M
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4.
A ESS_
Zlp
i
Type Const.
Occupancy
Sprinklered
7aleDyes
Z
❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW El ALT. ❑ AWN. RPL. El MVE. WORK ❑ BLD. �PLMB. ❑ MECH. ❑ M.H. El POOL ❑OTHER
7. OF ❑
Certifi.ofExempt.
Required
Yes El No❑
Number
or Variance
Received
Yes❑ No[]
DESCRIBE WORK�r
8. ���' "I
Shorelines/Flood Hazard
Plans Required ❑
Yes El Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
WATER PUBLIC ❑ SEPTIC SEWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑ SEWER ❑
Public ❑ Private ❑
1 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 presume to give au-
thority to violate or cancel t e provisions of an her state or local law regulating construction or the performance
Z &,o
of construction. SEE REVISPIMSIDERE WIRED INSPECTIONS
Plumbing
1FOR
SIGNATURE OF APPLICATI ` Lf
GP.P�L
OWNER OR AGENT DATE t
Mach.
SPECIAL APPROVALS
SPE AL COND IONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
Planning I to _ S, t v
Fire „
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. i
SEPA
Modular/
MFG. Home
Other (Specify)
Z600,TOTAL $
-WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE4SIL—g 1 4- 8 4 PERMIT&O.'5.8 z * 2 6. 0 0 TOOF-iAL