1983, 07-27 Permit: 83A-7045 Plumbing FixturesPLAN NUMBER APPL LCAT ION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHIWGTON 99260 / (509) 456-3675
TYPE KNEW ❑ ALT. ❑ AD'N. ❑ RPL.
❑ MVE.
APPLICANT: COMPLETE NUMBERED SPACES
—PRESS HARD TO MAKE 3 COPIES
PRIVATE ❑
SEWER ❑
STREETADDRESS
❑ POOL El OTHER
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
PARCEL NO.
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
Certif Lof Exempt.
Required
Yes❑ No❑
Number
of construction. SEE REV S 1 E FOR IRE qINSPECTIONS
or Variance
Received
Yes❑ No❑
OWNER OR AGENT 2 DATE 71
LOT
BLOCK
SUBDIVISION
Plans Required ❑
— 1—
LEGAL DESCRIPTION:
Yes Not Appiic. ❑
Received ❑
2.
SOURCE
OF
I
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
SEPA
Modular/
FEES COLLECTED
01Vi IMER
PHONE
PHONE
Vlk � !•✓
MFG. Home
3.
!u e_T-
_'ZXA.,
Prevent.
� l !'�i Ga 2
MA, LINd ADDRESS
ZIP
Actual Set Backs in Feet to :
Other (Specify)
Enaineer
I
rEw
North South
East West
CrafQJRACTOR
LICENSMS
PHQNE
Size of Parcel
-'
Zone Classification
Residential ❑
Commercial ❑
4
C, t-
z2� 14J2 I"
J
ESS
&99
ZI
Type Const.
Occupancy
Sprinklered
Dyes ❑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 KNEW ❑ ALT. ❑ AD'N. ❑ RPL.
❑ MVE.
PRIVATE ❑
SEWER ❑
% OF WORK ❑ BLD. �PLMB. ❑ MECH. ❑ M.H.
❑ POOL El OTHER
I 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
Certif Lof Exempt.
Required
Yes❑ No❑
Number
of construction. SEE REV S 1 E FOR IRE qINSPECTIONS
or Variance
Received
Yes❑ No❑
OWNER OR AGENT 2 DATE 71
8 DESCRIBE WORK
SPECIAL APPRO AL
Shorelines/ Flood Hazard
Plans Required ❑
— 1—
Plan Check
Yes Not Appiic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
SEPA
Modular/
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
I 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 t r isions of any other state or local law regulating construction or the performance
of construction. SEE REV S 1 E FOR IRE qINSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT 2 DATE 71
Mech.
SPECIAL APPRO AL
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
j� `� /� ✓
( l
Plan Check
Env. Health
J
— �G 1 �� r
SEPA
Modular/
Planning
Vlk � !•✓
MFG. Home
Fire
Prevent.
� l !'�i Ga 2
��-
Other (Specify)
Enaineer
I
i
/- r' k=�--
Plans PERMIT IS NONTRANSFERABLE
Exam. 4PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building '\ / IN 180 DAYS
PERMIT NUMBER
2�
TOTAL $ __1�L._`'�-'
WHEN MACHINE VALIDATED IN THIS SPAC
THIS BECOMES A PERMIT.
DATE ISSUED PERMIT NO.
*45.00a�j-
TOTAL
CL
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LL