1983, 07-14 Permit: 83A-6487 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
Received Yes❑ No❑
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
Shorelines/ Flood Hazard
Plans Required ❑
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Yes❑ Not Applic. ❑
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
� ;3�;I_ 117_�
f7tc
PARCEL NO.
WATPUBLIC ❑
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
UTILITIES
I
PRIVATE ❑
SEWER ❑
OW ER
P ONE,,-
PHONE
3.
Building
�
/�—ly�
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 REQUIRED NSPECTIONS
MAILING ADDRESS
URE OF APPLICATION
ZIP
Actual Set Backs in Feet to:
Mech.
SPECIAL APPROVALS
SPECIAL CON DIT : (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
North South East West
Plan Check
CONTRACTOR I
LICENSE EXPIRES
RUON �./'
Size of Parcel
Zone Classification
Residential
Commercial ❑
4.
V
SEPA
Modular/
MFG. Home
Planning
Fire
Prevent.
AD ss i ,/ (�
✓)
ZIP �t0
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
j q , , r -,n
��G� '/ _(
DESIGNER
Engineer
O E
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 /NEW ElALT. ElAD' N. 11RPL. ElMVE.
7•
OF
�PLMB.
❑OTHER
Certif I. of Exempt.
Required Yes❑ No El
Number
K ❑ BLD.
❑ MECH. ❑ M.H. ❑ POOL
WOR
or Variance
Received Yes❑ No❑
DESCRIBE WO K
8•
Shorelines/ Flood Hazard
Plans Required ❑
f
Yes❑ Not Applic. ❑
Received ❑
VALUATION I
SOOURCE
GAS
ELECTRIC
WATPUBLIC ❑
SE TIC O
Ownership
FEES COLLECTED
9•
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
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 REQUIRED NSPECTIONS
Plumbing
URE OF APPLICATION
7�_��
OWNER OR AGENT DATE �"!
OWNER
Mech.
SPECIAL APPROVALS
SPECIAL CON DIT : (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
( 1�t . I "li }
1 .
Plan Check
Env. Health
V
SEPA
Modular/
MFG. Home
Planning
Fire
Prevent.
j q , , r -,n
��G� '/ _(
Other (Specify)
Engineer
Utilities
TOTAL $
Plans i I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech.ing IN 180 DAYS
PERMIT NUMBER
- lv 4 7
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07F-14-£3 548,76E *49,00°
DATE ISSUED PERMIT NO. TOTAL
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C
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