1984, 02-07 Permit: 84A-1057 Plumbing FixturesPLAN NUMBER APPLIICATION /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 5 /O 164- 1— �% PARCEL NO. . L /QIZ�;
2. LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNN��
PHONE
PHONE
ArVe �'
3. 4
I
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
TRACTOR
t�L ��/,gavi�t�4
LICENSE EXPIRES
PH E
-�,
Size of Parcel
Zone Classification
Residential
4. lw
_
Commercial ❑
ADDRESSType
`Z
Const. Occupancy
Sprinklered
❑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
s.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW El ALT. ❑ AD'N. El RPL. 11 MVE.
OF 7. ❑OTHER
WORK ❑ BLD. PLMB. ❑ MECH. ❑ M.H. El
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes No 11
DESCRIBE WORK}
8• D Fle-
Shorelines/Flood Hazard
Plans Required ❑
/
Yes Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
PUBLIC O
SEPTIC SEWAGE
1
Ownership
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
d "L
of construction. SEE REVERSfftDFAP0Ttj EOUIRED INSPECTIONS
Plumbing
SIGNATURE OFAPPLICATION 12 ��
OWNER OR AGENT - DATE
Mech.
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech. �J ,
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
t 6
GvL}5lI
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 $ -;Pv-�
RRtOXIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIS�UEW 7 PERM17IN6.
*SU.U0�QaAL
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