1984, 03-28 Permit: 84A-2670 Plumbing FixturesPLAN NUMBER
APPLICAI
SPOKANE COUNTY — DEPARTMEI .. .rrdG & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 '
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES;
STREET ADDRESS
1.
• East 11011-13 Mission
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
O NER
3
OCCL�4`c�
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs In Feet to:
North ISouth [East .I West
00y ;ACTOR LICENSE EXPIRES
4. �cvt cT4v*C.al44. to 5/-93-
ADDFi€ 2O 3
Lt -
PHONE
Size of Parcel
Type Const.
Occupancy
Zone Classification
Residential 0
Commercial 0
Spr nklered
EYes UNo ❑Req'd.�
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage '
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE SEW 0 ALT. D AD' N. 0 RPL. 0 MVE.
WORK 0 BLD. f! :LMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesD No❑
Received VesO No❑
Number
8.
DESCRIBE WORK ^O FiC
Shorelines/Flood Hazard '
YesD Not Apollc.0
Plans Required 0
Received 0
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public O Private 0
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 REVERS E -S IDQ'FOWBEDUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
4
APPLICATION Ye 23 t' f
DATE
SPECIAL APPROVALS SPECIAL CONbITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam
Building
Tech.
cFwC
qists
.� TJ"Ss
a�hoA.,l�3
LtiA.SGi
tg_ FO
3
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 $ ao
PERMIT NUMBER
8`}A - 2&70
03* *90.00
*90.006
A *000 S
2661
03-28-84
2 6479.
.I
41
0-
0
0
W
J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ED
r"J Y,
q (( kd
PERMITN&.1. O 2
*90. UTUtAL