1984, 02-17 Permit: 84A-1355 Plumbing Fixtures PLAN NUMBER APPL ICAT1ON/PERMIT PERMIT NUMBER_
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY e/A - i 31
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 5 /a / 0e.2og / ff5 ,
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERP ONE PHONE
[rIf /v/k �oraAr, ..,1ydy 17
3 MAILING ADDRESS'// / ZIP Actual Set Backs in Feet to:
/70,22/ GU //�a'.S//7 �/ / 5 j/C/n4ijt C� ' / North (South East 1 West
4 CQ[JTRACTOR - / , LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
C / ce/rh C e t z4 h /w c, / L� 5-.i sU s' Commercial❑ . X v
ADD ESS ✓
ZIP Q�j Type Const. Occupancy Sprinklered * '-L U G
Si 9 2 / 13 004//--/-
` J/ d4�w/z l /�� Z— ❑Yes ❑No ❑Req'd.
It
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ' Ali
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
c — 17- 4
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement 4
6. ,
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE N NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. PLMB. ❑ MECH. ❑ M.H. ❑ POOL CeVai�ofofExempt. Required Yes❑ No❑ Number
or Received Yes Non
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. Yes Not Applic.❑ Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. PUBLIC❑ SEPTIC❑
PRIVATE CI SEWER❑ Public❑Private 1=1UTILILITIES
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 Building
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 G
of construction.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF /_� APPLICATION t�
OWNER OR AGENT 7 / / X I' Pt /Zs DATE s — / Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health
SEPA
Planning
Modular/
MFG.Home )-
Fire
Fire G.
Prevent. O
V
Engineer Other(Specify) W
- J_
Utilities / .°-5.'
C 6L
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE, S
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. I
Exa`n' ^�� PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED --
1.,3 Building �// 2 IN 180 DAYS DATE Ebl 4 PERMIT5'5 z * 4'6. 0 O,FoCD T L
Tech. /' ��