1983, 04-06 Permit: 83A-2659 Water HeaterPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
L NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
1. STREET ADDRESS PARCEL NO.
2. BL
LOT OCK SUBDIVISION LEGAL DESCRIPTION:
OWNER �/�
C/
PHONE
PHONE
3.
MAILING ADDR`ESS`�
Zlp
Actual Set Backs in Feet to:
North South East
West
CONTRACTOR 1 /
>i
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
//- - �.j
3L
Commercial ❑
4.
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
J.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
YPE El NEW El ALT. El AD'N. `R�RPL. ❑ MVE.
TOF
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. ❑OTHER
WORK El BLD. 1-1PLMB. 11MECH. 1:1M.H. El POOL
Certifi of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK
/J
, r /�� y� - � j � �
mesNo
Plans Required El
OF f i"
�❑ShorePazar❑d
Received ❑
VALUATION
SOOURCE
GAS
ELECTRIC
PUWATER
BLIC ❑
SEWAGE
SEPTIC ❑
1
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
'/0'P0
OWNER OR AGENT__ DATE
Mech.
SPECIAL APPROVALS
Env. Health
Planning
Prevent.
Utilities
SEPA
Plans
Exam.
Building
Tech.
ONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
�Qo
TOTAL $ /
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUEDO — 8 PERMITNJ. "' 9 z
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