1984, 02-10 Permit: 84A-1173 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
STREET ADDRESS PARCEL NO.
A P"
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
3.
OWNER ER ✓^ � � �� PHONE P (}f,JE o
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
SPECIAL
APPROVALS
North South East
I West
PRELIM.
CONTRACTOR
�7
DATE
LICENSE EXPIRES
P O
Size of Parcel
Zone Classification
Residential
PlanningFir
Commercial [I4.
Prevent.
ADDRE6S
ZIP
Type Const. Occupancy
Sprinklered
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PERMITISNONTRANSFERABLE
.,G
ctcl ?Z"l
Utilities
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building
Tech.
ADDRESS
!�
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
I
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW El ALT.
1-1 AD'N. El RPL. El MVE.
7
OF
❑OTHER
WORK ❑BLD. (�PLMB.
❑ MECH. 11 M.H. El POOL
Certifi.ofExempt.
Required
Yes El No[-]
Number
or Variance
Received
Yes El No❑
8•
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
Yes El Not Applic. ❑
Received ❑
VALUATION
I SOOURCE
GAS
ELECTRIC
PUBLIC ❑
SEWATER PTIC ❑
Ownership
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
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 the
provisions of any other state or local law regulating construction or the performance
of construction. SEE REVE
IDE FOR REQ I INSPECTIONS
Plumbing
SIGNATURE OF
APPLICATION
�__.
OWNER OR AGENT
I' DATE
Mech.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTI )
PRELIM.
FINAL
DATE
� � � .� t �e1�/�1 '{ l _ � . 1 �•
Env. Health
PlanningFir
Prevent.
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PERMITISNONTRANSFERABLE
Engineer
Utilities
SEPA
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building
Tech.
!�
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
!7/
TOTAL $ —�--
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISJUEDI_ a ,' PERMIT!I1.7 z *4. 0 0 b0DAL
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