1983, 02-23 Permit: 83A-1250 Plumbing FixturesNUMBER __-- APPLICA 7 ION/PERMIT
04 SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDJRESS
1.i - � CA/ 4�L,
LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUBDIVISION I PARCEL NUMBER/S
OWNER
PkiONE
ZZ
3.'
ADDRESS �.
Co r h
ZIP
Actual Set Backs in Feet
�
f ! !C .
North South East
West
CONT CTP,,I ' k
PHONE-
Size of Parcel
Zone Classification
4. ADDR /I
ZIP`
Type Const.
Occupancy
Sprinklered
/s
M1
j{%
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor I Upper
Floors
Garage Area
I Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Baseme
6.
I
No. Baths
No. Stories
No. Rooms
No. of Dwel
TYPE � NEW ❑ALT. 1-1 AD -N. 1:1 RPL. EI MVE.
7. OF
El BLD. PLMB. ElMECH. ❑ M.H. 1-1POOL❑OTHER
CERTIFICATE
Req'd.
Recd.
Not R�
WORK
of EXEMPTION
I
DESCRIBE WORK
Enum. Dist.
Location (Area)
8. ��)
FEES COLLECTED
VALUATION
SOURCE
GA
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
OF
I UTILITIES
Public El ElSingle
$
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 resume
Building
to give authority to violate or cancel the provisions of any other state or local law regulating construe o or the
performance of construction. SEE RE ERSE SIDE FOR REQUIRED INSPECTION 1
Plumbing
DATE OF APPLICATION SIGNATURE OF APPLICANT A
Mech.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ing Te lciaj�
SPECIAL CONDITIONS:
W
/�
1�J
til LJ/ 1`N4,x
PERMIT IS NONTRANSFERABLE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
0"* *29,00
*2900"
A L' v
1 24.9 -
C,2_2.5-8 3
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 z z ��._ : 3. 12' '5; 0' z
*29,00 00 � -