1982, 12-03 Permit: P82B-1603 Plumbing FixturesPLAN NUMBER
l.?
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANt, WAsiIINGTON 99260 / (509) 456-3675
APPLICANT; COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
IIS
</,\t
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3.
OWo R I IJ N J i -►� .
MAILING ADDRESS
P#74,
7750
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 'South
East I West
CONTRACTQR
a. j<I 0 pL;L)Kil�i ►\
.
ADDRESS
\J
DESIGNER
5.
LICENSE EXPIRES PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
7Y2 -a4 -
PHONE
Type
Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0/NEW ❑//ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. ❑ OTHER
WORK ❑ BLD. gPLMB. E MECH. ❑ M.H. ❑ POOL
8.
9.
DESCRIBE WOPK
VALUATION
SOURCE
UTI LLIITI ES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER ❑
1 Certifi. of Exempt.
or Variance
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Required Yes❑ No
Received Yes No
Number
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
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-
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
SIGNATURE OF(��, /(� APPLICATION
OWNER OR AGENT (;)�'- L/ DATE 12— Z --
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/2 -
SPECIAL
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
I L%t
6.
{ -(J*
vJ.�
<ii INJI(,
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
&CT)?"
1
0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE I9S E O -8 PERMIT N10/.5z * 0 TOTAL