1983, 10-21 Permit: 83B-684 Plumbing FixturesPLAN NUMBER IAPPL ICAT ION /PERMIT
PERMIT NUMBER
4
SPOKANE COUNTY — DEPART,MENT OF BUILDING & SAFETY
(�3
cli NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS
PARCEL NO.
�. .5;, -_;;2-2--7 i6,
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
I
I
OVyNER�f
PHONE
PHONE
3. C��-
MIAAI`L'`IIN ADDRESS
ZIP
Actual t Backs in Feet to:
North South East West
CONT
C ORS
LICENSE EXPIRES
ON
Size of Parcel
Zone Classification
Residential
Gs �� (
Commercial ❑
4.
ADESS
D6,
ZIP
Type Const.
Occupancy
Sprinklered
r,
` ' ! /
��o /
Dyes ❑No ❑Req'd.
�r
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
FJ.
ADDRESS
ZIP
Main Floor UpperFloors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
El OTHER
_T
WORK ❑ BLD. El PLMB. El MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBE WORK `
8.
Shorelines/ Flood Hazard
Plans Required ❑
I I V, X--rjP&1_7f_
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
PUB WATIC ❑
SSEWAGE EPTIC ❑
Ownership
FEES COLLECTED
9•
I
UTILITIES
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
of construction. SEE REVERSE SIDE FOR REQUARED INSPXC_TJQNS
Plumbing
SIGNATURE OF APPLICATION / f�%
OWNER OR AGENT DATE < ``
Mach.
SPECIAL APPROVALS
SPECIAL CONDITION E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
` f
I �`f M1v jl:�,
ZG
�C✓
SEPA
Planning
Modular/
MFG. Home
Fire
j V j pot __
Prevent.
Engineer
IV� `� — v
Other (Specify)
Utilities I,
WI�
SEPA 1 .-f rA-A/
Plans i I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. 10/Z 11 " IN 180 DAYS
TOTAL $ J;2�=
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
E,
DATE'1 UEC 1 — 0 ) PERMIT N6.8. 4 23 * 4 9. Q (i �OAL
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