1983, 11-23 Permit: 83B-1971 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
96 h / I b v
LOT
BLOCK
PARCEL NO.
SUBDIVISION
LEGALrbESCR;PTION:
OWER
3. (5 rot) 0 ,ge,1C >✓
MAILING ADDRESS
(;C, A/1- L'ObacV
CO RAC1OR
it-/ f , f— 0-r6
a. AD l 7/0 biAN4
PHONE.
9. ,-7 3 Ciil
PHONE
•
qc C4 -
LIC SE XPIRES
7/x>i
PHONE
9 —;2/00
Actual Set Backs in Feet to:
North (South
Size of Parcel
East I West
Zone Classification
7n2/L
Type Const_
Occupancy
Residential ❑
Oommercial ❑
Sprinklered
❑Yea ❑No ❑Req'd.
5.
DESIGNER
ADDRESS
6.
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE 0 NEW 0 ALT. 0 AD' N. 0 RPL. 0 MVE.
7• OF
WORK 0 BLD. 0 PLMB. kMECH. 0 M.H. 0 POOL
0 OTHER
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
8. DESCRIBE WORK
VALUATIO�1 SOURCEOF
9-7�T UTILITIES 1
)GAS
r WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Required Yes❑ No
Il Received Yea❑ No0
Number
Shorelines/Flood Hazard Plans Required ❑
Yes❑ Not Applic. ❑ Received 0
Ownership
Public ❑ Private ❑
I hereby certify that 1 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 REQUIR D INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION //'
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
)1�
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)
l•)
TOTAL $ f l 66
PERMIT NUMBER
&N3.-- 07'
04* *14,00
*14,00
A *000 n
1970
11-23-$3
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
J 5
DATE ISSUED PERMIT NO. 7. 1 z * 1 r U TOTAL