1984, 01-13 Permit: 84A-367 Mechanical FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NuFvFB--ER-
HA
—C1 -7
ri )) /i G 0 O J
PFFlMIT Nra' IJ, / � � G ��o b('f�Al
13
C
C.
u
u
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
Received
Yes❑ No❑
STREErADDRESS_
6 X00 `i 6alxl�d
PARCEL NO.
Shorelines/ Flood Hazard
Plans Required ❑
LOT
BLOCK
susolvlsloN
LEGAL DESCRIPTION:
FEES COLLECTED
2.
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-
NER
CU; �SZ1�
PHONE
9a� �yi0
PHONE
of construction. SEE VERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
3.
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS SPECIAL COVITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE /rJ ��
MAILING ADDRESS
ZIP
ActualSet Backs in Feet to:
7400 T J �d r dsrJ
Planning '��'�"�� ✓
J/
North South East West
Modular/
NTRRACTOR y� 7
r
LICENSE EDX/PII ES
PHONE
✓1
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4.
/7S I K /�, /� f i /elf
O 7
�.
TOTAL $
SEPA
DRESS /�
_,'Z? (?,,L/
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No
❑Req'd.
Tech Ing / IN 180 DAYS
C
.4tl7 49
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
Fin. Basement
Unfin. Basement
s.
7.Deck
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE El NEW El ALT. El AWN. El RPL. El MVE.
7.
❑OTHER
WORK 11 BLD. ElPLMB. ElMECH. ElM.H. El POOL
Certifi.ofExempt .
Required Yes❑ No❑
Number
PERMIT NuFvFB--ER-
HA
—C1 -7
ri )) /i G 0 O J
PFFlMIT Nra' IJ, / � � G ��o b('f�Al
13
C
C.
u
u
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
8.111
Shorelines/ Flood Hazard
Plans Required ❑
yes F1 Not Applic. ❑
Received ❑
VALUATION SOOUFCE GAS ELECTRIC pUBLI E]SEPT SEPTIC 'SEWAGE Ownership
9•
FEES COLLECTED
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-
Building
thority to violate or cancel the provisions. of any other state or local law regulating construction or the performance
of construction. SEE VERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OFw APPLICATION
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS SPECIAL COVITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE /rJ ��
Plan Check
Env. Health
SEPA
Planning '��'�"�� ✓
J/
Modular/
MFG. Home
Fire
Prevent.
Engineer
Other (Specify)
Utilities
TOTAL $
SEPA
WHEN MACHINE VALIDAT
Plans PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT..
FERMI
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech Ing / IN 180 DAYS
1 11 _
DATEYSSUED'` J ' 1 1IL
PERMIT NuFvFB--ER-
HA
—C1 -7
ri )) /i G 0 O J
PFFlMIT Nra' IJ, / � � G ��o b('f�Al
13
C
C.
u
u