1983, 05-10 Permit: 83A-3837 Plumbing FixturesPLAN NUMBER
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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
1.
LOT
2.
BLOCK
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�SUBDIVf510N ,< `/
PRONE
3.
ILI DDRESS
C LICENoSEPIRES
53
ACTOR
4. ' ®®REQ t y I 111444
�t�
`£�� 1
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
PHONE
PHONE
ZIP
TO
TYPE XNEW ❑ ALT. ❑ AD' N. ❑ RPL.
7. OF
WORK ❑ BLD. APLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
Size of Parcel
Type Const.
East I West
Zone Classification
Occupancy
Residential 0
Commercial
■
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Main Floor
Cover Deck
Remode ed Valuation
Upper Floors
Uncv. Deck
Total Bldg. Floor Area
No. Baths
No. Floors
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILITIES
GAS
I hereby certify that I have
reverse side, and know the
work will be complied with
thority to violate or cancel
of construction. SEE RE
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPR o VA S
PRELIM. FI DATE
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
Certifi. of Exempt.
or Variance
Required
Received
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public 0 Private 0
read and examined this application and have read the "NOTICE" provisions included on
same to be true and correct. All provisions of laws and ordinances governing this type of
whether specified herein or not. The granting of a permit does not presume to give au-
prvisions of any other state or local law regulating construction or the performance
E FOR REQUIRE INSPECTIONS
APPLICATION o� `�Ja
DATE / 7
Fin. Basement
Greenhouse
No. Fin. Rooms
Yes CI No❑
Yes❑ No❑
Unfin. Basement
No. Dwellings
Number
Env. Heatth
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
A —
a—Ae
/
yjCae) r OPERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ : vC.J
PERMITNUMBER
�-
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED 1 0 — 8 3
PERMIT Ng837z *45.0TOTAL
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JOB N0. I q5 .. WATER it/So Zr c2 74E' d
-SCALE 1 " = 20'
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67
fHA CASE NO.