1983, 05-13 Permit: 83A-4004 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHIN QTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
,636S .6 ai1/4.).E.,2w,Ay
LOT BLOCK
SUBDIVISION
PARCEL NO.
OWNER
3. I'�� el• AI.D ivk
MA LING ADDRES�
PHONE
PHONE
LEGAL DESCRIPTION:
E &vE WA / rrep_46acve,5
CONTRACTOR ENSE EXPIRES
4. GioEd V SS`uw i
ADDRESS
ZIP
PHONE
53,-f -uoZZ.
Actual Set Backs in Feet to:
North I South East I West
Size of Parcel I Zone Classification
Residential ❑
Commercial ❑
ZIP
3
Type Const.
Occupancy
Sprinklered
[Nes ❑No ❑ Reg 'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 4IEW ❑ AI.T. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. LMB. ElMECH. ❑ M.H. ❑ POOL ID OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
DESCRIBE WORK
8. o
VALUATION SOURCE
UTILITIES
O
9.
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Plans Required ❑
Received ❑
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
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
SIGNATURE OF APPLICATION
OWNER OR AGENT 4441-,
DATE cV/a/r '
SPECIAL APPROVALS SPE¢IAL CONDITI
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
{'t
lic
clod/
: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ `
PERMIT NUMBER
83 A Li 00,-f
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUED1 3 0 > PERMITA� `. r
*45.00,tAL