1984, 02-07 Permit: 84A-1055 Plumbing FixturesPLAN NUMBER IAPPLICATION/PERM IT
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 PARCEL NO.
2. LOT t BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
MAILING ADDRESS
APPROVALS
ZIP
Actual Set Backs in Feet to:
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL
North South East
West
CO ACTOR // LICENSE EXPIRE
WJ -Aav L�&f''�yxe"" -
PH E
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
/tel (
4.
-
Planning
ADDRESS
ZIP�aI
Type Const.
Occupancy
Sprinklered
!!JJ
/
� L-
❑Yes []No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Utilities
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
--
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TO
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building4
Tech.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW El ALT. El AD'N. 11 RPL.
1-1 MVE.
7
❑OTHER
WORK ❑ BLD. ,APLMB. 1-1 MECH. El M.H.
El POOL
Certifi.ofExempt.
Required
Yes No❑
Number
or Variance
Received
Yes NoF1
DESCRIBE WORK(/ y
8• -/
Shorelines/Flood Hazard
Plans Required ❑
>G�
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9
SOOUFCE
GAS
ELECTRIC
PUBLIC Ll
SEWATER PTIC F-1
COLLECTED
UTILITIES
PRIVATE 1-1
SEWER 101
PrivateFEES
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 REVE ID QUIRED INSPECTIONS
Plumbing
SIGNATURE OF
APPLICATION
OWNER OR AGENT
DATE _ �_
Mech.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL
DATE
3 �
Env. Health
Planning
/
Fire
Prevent.
/ ��
�t54r o-�. "'
l
Engineer
Utilities
.l
PERMIT IS NONTRANSFERABLE
SEPA
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building4
Tech.
I
1 7 41
Plan Check
SEPA
Modular/
MFG. Home
P MIT NUMBER
A-1C.1T
Other (Specify)
TOTAL $ S
WHEN MACHINE VALIDATED IN THIS SP
THIS BECOMES A PERMIT.
D,6s�,,E� 7 - n. PERMITI"�. 5. 5 z * 6 6. 0 0 SAL
Y
IL
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