1983, 05-03 Permit: 83A-3575 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING GODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3
JOB ADD Ir55
SUBDIVISION
LOT
BLOCK
0
LEGAL DESCRIPTION - SEE ATTACHED
(175-0-agit-12,14..6
ADDRES !
CO TRA TOR
DESS
DESIGNER
5.
ADDRESS
(7Z_
(`_ISI P.
PH`OriN11
`61(4 tZ
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South East (West
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD'N.
7. OF
WORK ❑ BLD. ❑ PLMB. (MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRI E WORK i.
8. ' i [`_ ti (i.
VALU ION
SOURCE
OF
UTILITIES
Enum. Dist.
Location (Area)
GAS ELECTRIC USE CODE
9. x
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
e of work will be complied with whether specified herein or not. The granting of a permit does not presume
give authority 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 INSPECTION
DATE OF APPLICATION - 32 fg ) SIGNATURE OF APPLICANT 2 L` tr --1, 4,-- )
WATE R
SEWER
Ownership
Public ❑ Private ❑
.""))
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. /k I: �.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ (.
PERMIT NUMBER
04* * 1 4.00
*14.006
A *000 ES -
357,42
05-03-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
06;i-.03:.-83
DATE ISSUED
557, 5z
*140'0° _
PERMIT NO. TOTAL