1984, 04-06 Permit: 84A-3052 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
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 • ��
1. "l Gt�t
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
OWLNR
3. a-- 1-2644 �'
�AIAILIN ADDRESS ee
611
CORACT4R �'[j n.
�/ B LICENSE 5ximei
4. :w:+Lv �'✓i i /i -4 l /z
AO SS
lid ! :az.:.
DESIGNER
5.
PI-(SjN E
PHONE
ZIPP
Actual Set Backs in Feet to:
North (South
PHONE
Size of Parcel
ilZone Classification
East
West
Residential ❑
Commercial ❑
ZIP
�l.
1
Type Const.
Occupancy
Spr'nklered
❑Yes 0 N ❑ Reg 'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 1EW
7• OF
WORK ❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
,PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes❑ No❑
Yes❑ No❑
Number
8.
DESCRIBE WORK
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
OF
UTILITIES
GAS 1 ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER ❑
Ownership
Public 0 Private 0
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 • .visions of any other ate or local law regulating construction or the performance
of construction. SEE REVS S DE FO .:�x•I0 E NSPECTIONS
SIGNATURE OF
OWNER ORA ENT NellIMEM DATECATION
SPECIAL APPROV4LLS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
t' Poe r O --,l
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DAT�S it,Ed16 - �� 4
PERMI10.5, 2 z
*82.00ROAL