1983, 08-18 Pemrit: 83A-7949 Plumbing FixturesPLAN NUMBER APPL ICAC ION /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
STREETADDRESPARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNSR -�� PHONE PHONE
3. ic' 1p '
LING`A15DRESSZI
PERMI
NUMBER
l
_7
LING`A15DRESSZI
Actual Set Backs In Feet to:
7 tilC e—,
North South East West
CQLTIRACTOR
LICENSE E PIRES
PHONE _
r
Size of Parcel
Zone Classification
Residential ❑
kl,
— Q
Commercial ❑
4. f
ESS
I
Type Const.
Occupancy
Sprinklered
PI �)
a❑Yes
❑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.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. 11MVE.
% WORK ❑ BLD. J<PLMB. ElMECH. ❑ M.H. ❑ POOL ❑OTHER
OF
Certifi. of Exempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
8 DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
- / )(
Yes E] Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
I
PRIVATE ❑
SEWER ❑
public El Private El
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
Building
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 th ro &ions of any other state or local law regulating construction or the performance
of construction. SEE REVE SE D FOR IRED SPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL APPRO AL
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE
PRELIM. FiNA ATE
/ 1 /,�
Plan Check
Env. Health
/ [ cs� /Dpi`
SEPA
Planning
—a
Modular/
% %
_ j�
MFG.Home
Prevent.
Pians PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Other (Specify)
TOTAL $ j
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
ud-16-63
DATE ISSUED PERMIT NO. z * O Oli&AL
0
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