1984, 03-02 Permit: 84A-1796 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACF-S - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
W R
"MAI
ON
PHONE
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
NTRACTO,
Sc
LICENSE EXPIRES
PH, NE
Z.
Size of Parcel
Zone Classification
Residential❑
Commercial ❑
.tJ'
4•
-t%t/
ADD E
ZI { y /
Type Const. Oocupancy
Sprinklered
7 4f- r� A/ %�
L-�,
Oyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
P
hi
Main Floor Upper
loors
Floors]
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncw. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE El NEW ALT. El AWN. ❑RPL. 11 MVE.
,
7• OF ❑OTHER
WORK El BLD. ❑ PLMB. ❑ MECH. ❑ M.H. El POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yea❑ No❑
8• DESCRIBE WORK r
A.
Shorelines/ Flood Hazard
Plans Required ❑
Jf
Yes❑ Not Applic. ❑
Received ❑
ALU _101911A
9. Z '-t ,
SOURCE
OF
OF
GAS
ELECTRIC
1
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
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 provisionspt,,any other state -or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED I CTIONS
Plumbing L)
SIGNATURE OF APPLICATION F
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
o f
(rot
r r
SEPA
Planning
9A4, /A, I
l�
Prevent. trJf?► s�/`%�
Engineer
Utilities � •��✓�i%���r/tiLil i/ /
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building j IN 180 DAYS
Modular/
MFG. Home
her (Specify)) ,LIQ
TOTAL $"
RIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
2—r]4
DATE ISSUE PERMITj 7 �7
0.9, 6 z
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