1983, 08-11 Permit: 83A-7619 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY = DE'PARTMEI T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
/V /2(' / , //Cc -4x1
LOT BLOCK SUBDIVISION
PARCEL NO.
LEGAL DESCRIPTION:
O�LEft-
3, // L p, i I_ Jei
�^ AILIN A DRESS
N7RACTOR
4. A rLIr dtI IJ/i� Jiti'2
PHONE
5
PRONE
./%r/
ZIP/ c /
Actual Set Backs in Feet to:
North ISouth {East I West
LICENSE
PHONE
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
DESIGNER
5.
ADDRESS
ZIP
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes No Req 'd.
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE fi%NEW ❑ ALT. ❑ AD' N. E RPL. ❑ MVE.
%• OF ❑ BLD. LMB. E MECH. ❑ M.H. ❑ POOL
WORK
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes❑ No❑
Number
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILITIES
11)
� - t )(la re's
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER 0
Ownership
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-
thority to violate or cancel the • vins of any other state or local law regulating construction or the performance
of construction. SEE REVEFOR REQt1ITjED II44PECTIONS
SIGNATURE OF / A U APPLICATION���/3
OWNER OR AGENT���/ DATE
SPECIAL APPROVALS
PRELIM. FINAL' .ATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Wit
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/-
{•) idet.dce
- 4,112./latree
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 $
PERMIT NUMBER
se, A -7 Co 19
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�QQ , 7 ,(( 1
DATEVSSUEDL 1 8 3 PERMITIN . 1, 9 z * 4 5 0 01OIFAL