1983, 06-16 Permit: 83A-5367 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY --- DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE; WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
A s co
APPLICANT: COMPLETE NUMBERED SPACES – PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
,.
PARCEL NO.
aF s -2o
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
OWNER
v! t!uJ �}�5
PHONE
PHONE
3./Cid
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East West
C NTRACTOR
LICI�NSE EXPIR S
PHON7
Size of Parcel
Zone ClassificationT
Residential ❑
4. D�I{L jy�fJr4t�lGAG� .-
�3�
'f�l
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
3 (=- Ozrs
y�o?/C
I
Dyes []No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage/Storage
Greenhouse
.l .J
CHANGE OF USE FROM
TO
Cover Deck Uncw. Deck
Fin. Basement
Unfin. Basement
C
TYPE 9CUW El ALT. El AD' N. El RPL. ❑ MVE.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
7• OF WORK El BLD. .�PLMB. ElMECH. ElM.H. El POOL El OTHER
Certifi.ofExempt.Required
Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBE WORK 3
8• �/ 1� ?v C if
Shorelines/ Flood Hazard
Plans Required ❑
Yes Not Applic. ❑
Received ❑
VALUATION
9•
SOOUFCE
GAS
ELECTRIC
WATPUBLIC ❑
SEPTIC G❑
Ownership —F
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERS SIDE REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATIONS
4=1f �3
OWNER OR AGENT DATE _�S�
Mach.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
(X..2 e—
Plan Check
Env. Health
r`J
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
lr
Other (Specify)
Engineer
1!�
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech
I N 180 DAYS
6 16 -8 3
�j �j 5 7 c
"' 7 5 * " /. O
DATE 1 PERMIT
IfO5 TOTAL
A
C
C.
U
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