1983, 02-03 Permit: 83A-809 Plumbing FixturesPLAN NUMBER
APPLICATION/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
1 SIRE ADD E � � i 15 PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER,�� tF� ^ PHONE
3.
SPECIAL AP OVALS SPECIAL COND
Env. Health
PRELIM. FINAL DATE
I � 9
Planning
Fire
Prevent.
Engineer
Utilities
(SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building r Z IN 180 DAYS
Tec
Plan Check
SEPA
Modular/
MFG. Home
PERMIT NUMBER
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
zDATASJ PERMIT OOno
* 17.0 0 i&AL
CL
C
C
LL
u
Mfia!NG
RESS `
��
Actual Set Backs in Feet to:
IV' '
2 ✓
North South East
I West
CO RA
OR
LICENSE EXPIRES
P N
Size ofParcel
Zone Classification
Residential❑
4.
Commercial ❑
A ESS _70 _2,0
!
`I
X
Type Const.
Occupancy
Sprinklered
(✓
❑Yes ❑No ❑Req'd.
D SIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROMTO
Cover Deck
Uncv. Deck
1 Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ AIT. ❑ AD'N. ❑RPL. ❑ MVE.
7.
❑OTHER
WORK ❑'BLD. PLMB. 11MECH. ElM.H. E]POOL
Certifi.ofExempt.
Required
Yes No❑
Number
or Variance
Received
Yes❑ No❑
8.
DESCRIBEWORK +
Shorelines/ Flood Hazard
Plans Required El
I
Yes Not Applic. ❑
Received ❑
9•
VALUATION
I SOURCE GAS
ELECTRIC
PUBLICER ❑
SEPT CGE
Ownership7
FEES COLLECTED
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
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
Imo/
of construction. SEE RSVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OFAPPLICATION (�
OWNER OR AGE DATE.3
Mach.
SPECIAL AP OVALS SPECIAL COND
Env. Health
PRELIM. FINAL DATE
I � 9
Planning
Fire
Prevent.
Engineer
Utilities
(SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building r Z IN 180 DAYS
Tec
Plan Check
SEPA
Modular/
MFG. Home
PERMIT NUMBER
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
zDATASJ PERMIT OOno
* 17.0 0 i&AL
CL
C
C
LL
u