1983, 06-29 Permit: 83A-5995 PipingPLAN NUMBER
r/
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANWASIi1NGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STR,F.A.T ADDRESS
1.
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
5.
ER
Iry ING ADDRESS
C / 5 -el 2 _
NTRACTO$-
_DDR )'v't.��J
ADDRESS
DESIGNER
PHONE
PHONE
ZIP
NSE EXPIRES
PONE
LEGAL DESCRIPTION:
ActualSet Backs in Feet to:
North 1 South 1 East I West
Size of Parcel I Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Sprinklered
EYes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW E ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ElMECH. ElM.H. ZEOOL ❑OTHER
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC C
PRIVATE
SEWAGE
SEPTIC ❑
SEWER ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Shorelines /Flood Hazard
YesE Not Applic. ❑
Ownership
Public ❑ Private ❑
Required Yes ❑ No❑
Received Yes No'7
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 REV E SIDE FOR REOUI D INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
APPLICATION/
DATE f1
2 9 2'
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
v�9
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/ c) / r
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 1
PERMIT NUMBER
u 4 *
*19.00
*1900:-'5
*0010
599.4
06-29-83
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
iI
DATE I S�U E DL
PERMIT O. 9' S z
*19.00 AL