1983, 09-08 Permit: 83A-8747 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKAI E, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS /
1.
LOT
2.
BLOCK
SUBDIVISION
OWNEppp
3. �l=dbdESS
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P ONE K
PHONE
LICENSEfPIRES
5.
ADDRESS
DESIGNER
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE $NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. A.PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC E
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
Type Const.
New Const. Valuation
Main Floor
Cover Deck
No. Baths
East
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
:Nes ❑No ❑ Req 'd.
Remode ed Valuation
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No❑
Received Yes❑ Nof
Shorelines/Flood Hazard
Yes ❑ NotApplic. ❑
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 provisions of any other state or local law regulating construction or the performance
of construction. SEE REV t IDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION G b /45,3
DATE
SPECIAL APPRO A S
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
l-
G1
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09--08-83 ,8N 47z
DATE ISSUED PERMI 6.
*4AUUlXQAL
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