1984, 04-17 Permit: 84A-3419 Water HeaterPLAN NUMBER APPL I+CAT ION /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.
2. LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNERS PHONE. PHONE
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to-
^�
North South East
West
CONTRACTOR LICENSE EXPIRES
P E i
Size of Parcel
Zone Classification
Residential❑
4.
Utilities
Comm ercial C
ADDRESS
ZIP
�7
Type Const. Occupancy
Sprinklered
❑Yes 11 No ❑Req'd.
��,
Building
Tech.
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
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
OF % WORK ❑BLD. ❑ PLMB. MECH. ❑ M. H. El POOL El OTHER
Certifi.ofExempt.
Required
Yes El No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
8•
Al?J!_�
Shorelines/ Flood Hazard
Plans Required
I i
Yes Not Applic. ❑
Received
VALUATION
SOURCE
U GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
LI
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
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
Plumbing
SIGNATURE OF C /�//¢, / )r APPLICATION
f 4 `�
OWNER OR AGENT �1� I `- ,(- J DATE �
Mech.
5PtGIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
�.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'llS3UED'-` / e PERIV1,4 B. L 9 z
* 2 0.0 0 RaFAL
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