1983, 10-05 Permit: 83A-9966 Mechanical 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
STREET ADDRESS PARCEL NO.
1 . M . i te,'i�iar a'
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3. I00t�
MAILING ADDRESS
ZIP
ZIP&_-2
Actual Set Backs in Feet to:
�� tt /
't
v ' V C-'�/ t
North South East
West
CONTRACTOR
LICENSE EXPIRES
"XE
�/
Size of Parcel
Zone Classification
Residential
4.
r LOO
al 0
ADDRESS
ALP—
Type Const. Occupancy
Sprinklered
I °
ZV 1
❑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 DeckUncv.
Deck
Fin. Basement
Unfin. Basement
S.
TYPE ��/ '
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
El ALT. El RPL.
7.
;ZECH.
13 MVE.
❑OTHER
WORK El BLD. ❑ PLMB. El M.H.
❑POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESS�CRIB.E�W-�ORK 1�
8'
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9•
I SOURCE
GAS
ELECTRIC
PUBLIC O
SEWAGE
1
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-
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 REQUIRER
INSPECTIONS
Plumbing
SIGNATURE OF ?;!-'C'r— I
OWNER OR AGENT —�
APPLICATION
DATE )O j
Mach.
SPECIAL APPROVALS SPECIAL NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. IPERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. /5
Plan Check
SEPA
Modular/
MFG.Home
PERMIT N MB
ER
0-
Other (Specify)
i�
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT.
DATEIISSUE� 5 -8 3` PERMIT"NO. oz
*] 900%YAL