1983, 12-08 Permit: 83B-2387 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
TO
APPLICANT: COMPLETE NUMBERED SPACES —
PRESS HARD TO MAKE 3 COPIES
Fin. Basement
STREE7�ADDRE
6.
NO.
1
aaVV►► F 17 ISI
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
Lor
BLOCK
SU IsloN
Utilities
DESCRIPTION:
2.
SEPA
Certifi. of Exempt. _T
Required
OWNER
Number
NE
PHONE
3.
Yes❑ No❑
DESCRIBE W RK
8
Shorelines/Flood Hazard
Plans Required ❑
-( x
MAILING AD�D7 ESS
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9•
ActualBacks in Feet to:
GAS
ELECTRIC
�j
SEWAGEE❑
Ownership
South East West
FConst.
FEES COLLECTED
UTILITIES
LICENSE EXPIRES
PHONE
cel
Zone Classification
Residential ❑
4.
WRCTR
c
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
Commercial ❑
Building
ADDRESS
of construction. SEE REVfRSEIDE FOR REOU I P T NS
ZIP
t.
Occupancy
Sprinklered
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
[]Yes ❑No ❑Req'd.
DESIGNER
PHONE
. Valuation
Remodeled Valuation
Total Bitlg. Floor v rea
5.ADDRESS
ZIP
r
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
Planning
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. El AD' N. El RPL. El MVE.
Utilities
7. OF ❑ OTHER
WORK ❑ BLD. LMB. ❑ MECH. ❑ M.H. ❑ POOL
SEPA
Certifi. of Exempt. _T
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE W RK
8
Shorelines/Flood Hazard
Plans Required ❑
-( x
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
WATT O
SEWAGEE❑
Ownership
FEES COLLECTED
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-
Building
thority to violate or cancel a provisions of any other stat local law regulating construction or the performance
of construction. SEE REVfRSEIDE FOR REOU I P T NS
Plumbing
SIGNATURE OF APPLICATIONS _
OWNER OR A G E N T44ZZ.4 DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
SEPA
Modular/
MFG.Home
PERMIT NUMBER
g —zz_4
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12- L- d. 8,7 Z'
DATE ISSUED PERMIT Iz
*29,70+O'FAL
LL
PRELIM.
FINAL
DATE
I�
W
I V PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
SEPA
Modular/
MFG.Home
PERMIT NUMBER
g —zz_4
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12- L- d. 8,7 Z'
DATE ISSUED PERMIT Iz
*29,70+O'FAL
LL