1983, 11-29 Permit: 83B-2092 Mechanical FixturesPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
Floors
Garage/Storage
PARCEL NO.
Z 7 AV, -
LOT
BLOCK
SUBDIVISION
CHANGE OF USE FROM
LEGAL DESCRIPTION:
2.
I
I
s.
OWNER ////
PHONE
PHONE
3.
t` as
Floors
q
No. Dwellings
MAILING A RESS
Certifi.ofExempt.
Required
ZIP
Actual Set Backs in Feet to:
Yes❑ No❑
Number
or Variance
North South East West
CONTRA,CPR R
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
1
Residential ❑
4. k e, 4
.P %%
I WATER
PUBLIC ❑
q26' lef 7
Ownership
Commercial ❑
ADDRESS
UTILITIES
ZIP
Type Const.
Occupancy Sprinklered
Q��
-
,7,7,7®�-
provisions included on
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
of construction. SEE REVERS IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF�sZtG� APPLICATION
U
OWNER OR AGENT DATE
Mach.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement Unfin. Baseme
s.
TYPE NEW ❑ALT. ❑ AD' N. ❑RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. WORK /❑\
BLD. ❑ PLMB.`,,MECH. ElM.H. ❑ POOL ❑OTHER
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK, /,/�,
K W
Shorelines/Flood Hazard
yes Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION I
9•
SOURCE
GAS
ELECTRIC
I WATER
PUBLIC ❑
SEPTISEWAGE
I
Ownership
FEES COLLECTED
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 REVERS IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF�sZtG� APPLICATION
U
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL GATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Engineer
Other (Specify)
Utilities
TOTAL $
SEPA
WHEN MACHINE VALIDATE
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
(/
I N 180 DAYS
11- 2 9- 6 3
DATE ISSUED
PERMIT NUMBER
PERMIT O. 9. 2 * 14. voirAL
O
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