1983, 07-22 Permit: 83A-6827 Water HeaterPLAN 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
PARCEL NO.
ST HE ADDRESS
1. ///i
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. MAILING ADDRESS
CONJRACTOR
4. -
ADDRESS
PHONE_
LICENSE EXPIRES
PHONE
ZIP
PHONE
/ 1
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North ! South
11 East I West
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 51,'N EW
7. OF
WORK ❑ BLD.
❑ ALT. ❑ AD' N. ,❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ Non
Number
8.
9.
DESCRIBE WORK
VALUATION
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required ❑
Received ❑
" SOURCE
F
UTILITIES
GA
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER E
Ownership
Public ❑ Private ❑
I hereby certify that I have read and examined this application and have read the "NOTICE" providions 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 REQUIRED INSPECTIONS
SIGNATURE OF/,/1 1 APPLICATION
OWNER OR AGENt - �� /- �l t . DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SES REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Cheok
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *1600
*16006
A *000
68262
07-22-83
2 6479,
CII CPADV
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07-22-83 682.72
DATE ISSUED
*16'0021
PERMIT NO. TOTAL