1984, 03-23 Permit: 84A-2531 Plumbing FixturesPLAN NUMBER APPLICATIONJ PERMIT
SPOKANE COUNTY — DEPARTM5NT 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.
LOT BLOCK SUBDIVISION LEGAL
2. DESCRIPTION:
OW ,A
//
PHONE
PHONE
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
CO TRACTO9 e
,�pu Stq(i /'L j -'W'4 0.'/e- pct
LIC SE EXPIRES
�3'TfY
PH}NE
`������
Size of Parcel
Zone Classification
Residential❑
Commercial ❑
4.
AD
9 �o�
ZIP /
Type 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
6.
TYPE ,n NEW El ALT. El AD' N. El RPL. El MVE.
,
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. OF ❑ OTHER
WORK ❑ BLD. CZLMB. ElMECH. El M. ElPOOL
Certifi. of Exempt.
Required
Yes❑ No
Number
or Variance
Received
Yes 1-1 Non
DESCRIBE WORK�� ��
8
Shorelines/Flood Hazard
Plans Required El
Yes El Not Applic. ❑
Received ❑
VALUATION
9
I SOURCE
GAS
ELECTRIC
WATER
PUBLIC 1-1
SEWAGE
SEPTIC 11
I
FEES COLLECTED
UTILITIES
PRIVATE ElSEWER
11Public
Public ❑Private [I
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
a'
of construction. SEE REVERSE SIDE FO UIRED INSPECTIONS
Plumbing
SIGNATURE OF - APPL ICATIOIj4�3
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
SPECIAL CON (TIONS: (SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tailing IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERN11T NUMBER
--3 1 J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED PERMIT NO.
*70.00°
TOTAL
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