1984, 02-29 Permit: 84A-1708 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
STREETADDRESS PARCEL NO.
1. EF `fit � i () `i�
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER,
PHONE
PHONE
Env. Health
Planning}I
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
,
North South East
West
CONT ACT R
i
LICENSE EXPIRES
PHON _
Size of Parcel
Zone Classification
pesidential❑
4. { �i
Utilities
SEPA'`
Commercial ❑
ADDRESS
' +�
ZI
Type Const. Oceupancy
Sprinklered
j V
Pians
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. 7
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
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
s.
I
TYPE NEW ALT. ❑ AWN. ❑RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. ❑OTHER
WORK ❑BLD. I,�PLMB. El MECH. ❑ M.H. ❑POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
8. DESCRIBE WORK ? �M ,n t N
es
Required 0
YesEl Not p ic.HazEl
Received ❑
VALUATION I
9•
SOOURCE
GAS
ELECTRIC
WATER IC ❑
SEPT CG❑
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
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 or state or local law regulating construction or the performance
L1 d
of construction. SEE REVER IDE FOR REOUIth D INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
L"ZI
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning}I
Fire
Prevent.
Engineer
Utilities
SEPA'`
PERMIT IS NONTRANSFERABLE
Pians
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. 7
IN 180 DAYS
d
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
e?�J' 00
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBEREl
DATETS &U 9 u PERMITNO. z * it fO#'AL
O
C
C
U
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