1984, 03-28 Permit: 84A-2669 Plumbing Fixtures1
PLAN NUMBER
APPLICAMN/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 _
1• East 11001-03' Mission
LOT
2.
BLOCK
SUBDIVISIdN
PARCEL NO.
3
OWNER
UJDL /C1—/411-0
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
ZIP
Actual Set Backs In Feet to.
North ISouth [East West
CONTRACTOR
4. aoc40 5fa<- Ifn ws-/e4/;�u
ADDRESS
/32-43
LICNSI EXPIRES
?-2-104(
P ONE
�s -3543
Slzeof Parcel ' 1 Zone Classif 'cation
Residential 0
Commercial 0
ZIP
tnP-
Type Const
Oceupa cy
Spr nklered
DYes No 17 Req
DESIGNER
5. ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg Floor Area
ZIP
Main Floor
Upper F oors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Carer Deck
Uncv. Deck
Fin. Basement
Unfin Basement
TYPE L¢NEW
7. OF
WORK O, BLD.
0 ALT. 0 AD' N. 0 RPL. 0 MVE.
04,MB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No Floors
No. Fin. Rooms
No. Dwellings
Certiti. of Exempt.
or Variance
Required Yes0 No❑
Received YesD .No0
Number
DESCRIBE WORK '
8.% F/1L
Shorelines/Flood Hazard
Yes❑ Not Apollo. D
Pana Req ired
Received 0
VALUATION
9.
SOURCE
OF
UTILITIES
GAS I ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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 REVERSE DE EOUIRED INSPECTIONS
SIGNATURE OF APPLICATION/74_234r 1(
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ q0°)
PERMIT NUMBER
80- - 24&'1
03* *90.00
*90006
A *000 8
26622
03-28-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
asa.y h'r. 4
DATE 15SUED2. 8 ;:4 PERMIT 6.
•5. 9 2
•
*90.00 Wm.