1984, 04-12 Permit: 84A-3278 Plumbing Fixtures PLAN NUMBER APPL ICAT,IO'I)/_PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPA`RTMENT OF BUILDING &SAFETY 014 - 3163,
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 50 20 ►J .
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3. i I'v)AM A CO tvt i•
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
----- G— J P01,1 E. North (South [East l West
CONTRACTOR��/ /� ,.w'n IOC
LICENSE EXPIRES P ONE Size of Parcel Zone Classification Residential 0 5 h ,
�VI✓ �'�•✓!'S V Old* • r'vc . 94.4 -3423 Commercial 0
4. ADDRESSy� r (ZAP Type Const. Occupancy Sprinklered
I"3Z3 FOtLsr IRVIf CO ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area '
5 ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE X NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF WORK ❑ BLD. �`PLMB. 0 MECH. 0 M.H. 0 POOL ❑ OTHER ariaweExempt.
or Required Yes❑ No❑ Number
Received Yes No❑
DESCRIBE WORKy �y 4 Shorelines/Flood Hazard Plans Required 0
8. c r 1 IJ Yes❑ Not Applic.0 Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
PUBLIC❑ SEPTIC 0
9• UTILLIITIES PRIVATE❑ SEWER 0 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 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 • - .ther state or local law regulating construction or the performance 'p• f?ey
of construction.SEE REVERSE SID O• REQUI-ED INSPECTIONS Plumbing
SIGNATURE OFCATION�� y(2 —Ertl
OWNER OR AGENT
` DATEMech.
SPECIAL APPROVALS SPECIAL CONDITION :(SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning Modular!
Fire
1 MFG.Home
Prevent. O
v
Engineer Other(Specify) LY
-J
ii
Utilities
��
_ TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ^ IN 180 DAYS J /� n
Tech. 7 lip, DATEUSSt/Ed 2 —8 4 PERMIT Iq.7 8 z *, 5 a a ri aO AL
ti' c U