1983, 05-02 Permit: 83A-3552 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
1.
STREET ADDRESS 9/ ? A/
LOT
2.
BLOCK
SUBDIVISION
OWNEB��
3. / Lt �'( X
yIAILING ADDRESS
6-eh3L5L�-
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COACTOR i />I / t� -
4. w t' a ru �.cAms,
PHONE
LICENSE XPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
TO
7 TYPE >KNEW ❑ ALT. ❑ AD' N. El RPL. ❑ MVE. . OF ❑OTHER
WORK ❑ BLD. APLMB. ❑ MECH. ElM.H. ❑ POOL
DESCRIBE WORK
8.
/G
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
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
❑Yes ❑No Req 'd.
Remode ed Valuation
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No El
Received Yes ❑ No 17
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
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 . r . sions of any other tate or local law regulating construction or the performance
of construction. SEE REV - . I E FO DIRE INSPECTIONS
SIGNATURE OF APPLICATION �/ //g
OWNER OR AGENT , �� DATE / /,
SPECIAL APPR e V ' LS
PRELIM. FI DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FO��E)��
l
f
I J l�CJ7/GJ
/ e r x;4,1
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
EZA
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IBSoED 0 2 - 8 3
PERMIT fltY. 5. 2
z *45.00 ° TOTAL
IL-