1983, 08-17 Permit: 83A-7892 Plumbing FixturesPLAN NUMBER
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 1 BLOCK
2.
4/70? H
SUBDIVISIO
PARCEL NO.
oweR
3. /uP C -r
MAILING RESS
RACTOR
y.rr�.
PHONE
22/,9/
PHONE
LEGAL DESCRIPTION:
P ▪ A RE
DESIGN
5.
ADDRESS
LICENSE cXPIRES
ZIP
PHONE
'S41-7
,/ l tom/
S4 J t)J/
ZI ,g1402a
PHONE
Actual Set Backs in Feet to:
North 'South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
East
West
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled 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 -NEW ❑ ALT. ❑ AD' N.
7. OF ❑ BLD. -PLMB. ❑ MECH.
WORK
8.
DESCRIBE WORK
VALUATION
9.
SOOURCE
UTILITIES
❑ RPL. ❑ MVE.
❑ OTHER
❑ M.H. ❑ POOL
D t7:'; X 4-2,(3
WATER
PUBLIC 0
PRIVATE 0
GAS
ELECTRIC
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ Non
Received Yes❑ No❑
Number
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required 0
Received 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 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 >ro isi- s of any other state or local law regulating construction or the performance
of construction. SEE REVE : S ' OR REOJ.li. ED I ` PECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPRO AL
PRELIM. FINAL • TE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
S(17
APPLICATION §3r� ��
DATE / j�
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/ H ►' 7
..5-kowle/1 21)et_
/ �.e._
/ - 5,;) k
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 $
16-°7
JLor-)
PERMIT NUMBER
83A 7 Z—
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 456D 1 7 - 8
789.22 *45.002 P
3 PERMIT NO. TOTAL
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ADDRESS � � 11774 /; /%, J,, Al - I STYLE HOME 9.
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APPLICANTSr i ' POW ER 1 /A/ l� ? r I I
I .rig
- - -
WATER (IA ASd/'di 41
SCALE
t."= 20'