1984, 03-07 Permit: 84A-1906 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
PARCEL NO.
1.
LOT BLOCK
2.
OWNER
3.
MAILING ADDRESS
4.
43.-_Z
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
PHONE
Zone Classification
ZIP
Actual Set Be
North
LICENSE EXPIRES
PHONE
Size of Parcel
Total Bldg. Floor Area
ZIP
Type Const.
Greenhouse
PHONE
New Const.
Unfin. Basement
ZIP
Main Floor
No.
PERMIT NUMBER
O,tA v (9(.(,
South Fast I West
Zone Classification
Residential ❑
Commercial ❑
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
,n
Remodeled Valuation
Total Bldg. Floor Area
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Floors I
No. Fin. Rooms I
No. Dwellings
TYPE I$.CIEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF 11 OTHER
CertifI.ofExempt.
Required Yes❑ No❑
Number
WORK EDBLD. WLMB. ❑ MECH. F-1 M.H. ElPOOL
or Variance
1
Received Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required ❑
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
I SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
I
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 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
i3
--
of construction. SEE SE SIDE F R tQUIRED INSPECTIONS
Plumbing
y, as
SIGNATURE OF _ APPLICATION
OWNER OR AGENT DATE _ _ _
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM.
FINAL DATE
r
3 'Tu ��- � 5
Env. Health
•
3 1 �� _j �j
SEPA
Planning
Modular/
U
MFG. Home
Fire
Prevent.
'je- S ,
Other (Specify)
Engineer
/ - D.s ��:�s �-�-
Utilities
/ "
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
PERMIT IS NONTRANSFERABLE
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildinE
"x
g IN 180 DAYS 3_ n 11 j ,j
Tech. j DATE-ISSUE15) PERMITINJ '. �• z*0,000-j *oIrAL
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