1984, 03-19 Permit: 84A-2349 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 STREETADDRESS A/ PARCEL NO.
2. LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3 k�4��v41C
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
SPECIAL APPROV
PRELIM. FINAI
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
3r
Y mat'
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
aw
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-,a
19-8611 23492
DATE ISSUED PERMIT NO.
*62,002
TOTAL
a -
O
W
J
LL
North ISouth East
West
CO,OWRACSize
LICNSE EXP
G��LY�"�
P�ON7c35%�
of ParcelTOR
Zone Classification
Residential ❑�l_
Commercial L1
4.
ADDRE
303
ZIP
Type Const. Occupancy
Sprinklered
❑Yes El No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TYPE ,t�NEW El ALT. 11 AD'N. ❑RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
OF 7 ❑OTHER
WORK 1:1 BLD. iZLPLM6. El MECH. El M. H. El POOL
Certifi.ofExempt.
Required
Yes El No❑
Number
or Variance
Received
Yes No7
DESCRIBE WORK/
8•
Shorelines/Flood Hazard
Plans Required LJ
`
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS ELECTRIC
WATER PUBLIC ❑
SEPTIC G❑
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
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_
a..
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF r �'v%l APPLICATION
OWNER OR AGENT DATE — _ _—_
Mech.
SPECIAL APPROV
PRELIM. FINAI
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
3r
Y mat'
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
aw
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-,a
19-8611 23492
DATE ISSUED PERMIT NO.
*62,002
TOTAL
a -
O
W
J
LL