1983, 09-12 Permit: 83A-8953 Plumbing FixturesPLAN NUMBER APPL ICAT 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
STREETADDRESS EA,j__ALALsPARCEL NO.
1.
2.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
OW Q..e� �2i1_.��� PHONE
AILING A15613ES
ZI
Actual Set Backs in Feet to:
LV
�I
North South East
West
40VRACTOR
LICE SE E01HU
PFWNE
Size of Parcel
Zone Classification
Residential ❑
.41'
S l
Commercial ❑
4.
DRESS
ZI
Type Const. Occupancy
1
1
Sprinklered
e L
❑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 FROMTO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE )KNEW ❑ALT.
El AD'N. ❑RPL. ❑ MVE.
7. OF
❑OTHER
__T
WORK ❑ BLD. �PLMB.
❑ MECH. ElM.H. 1:1 POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8. DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
PUBLIC ❑
SEPTIC SEWAGEWATER
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
I hereby certify that I have read and examined this application and have read the "NOTICE"
luded on
pTthe
reverse side, and know the same to be true and correct. All provisions of laws and ordinances s type of
work will be complied with whether specified herein or not. The granting of a permit does nogive au-
Building
thority to violate or cancel
r sions of an other tate or local law regulating constructiormanceof
construction. SEE REV RS
E FO EQU ED NSPECTIONS
Plumbing
SIGNATURE OF
APPLICATION�
OWNER OR AGENT
DATE
Mach.
SPECIAL
PRE
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
'ALI
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ `�
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
Pe5S A "�q�'�
DATE1 7UE� _ 8 3 PERMITNO. 5' 5 z * �' O %if'AL
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