1983, 11-02 Permit: 83B-1199 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
\
PARCEL NO.
LOT
BLOCK
SUBDIVISION
OWNER
3 .c-. CorJSX2tAf--"Cac.iV
MAILING ADDRESS
N. 1Z7 72 Pot VA-ot...)
CONTRACTOR
0 Arz cz ctF.f t N(�
ADDRESS
4.
2�3
Lt-, 'Or tC O C (.=►
PHONE
PHONE
6174 -2.1x,4(.
LEGAL DESCRIPTION:
ZIP
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North 'South
Size of Parcel
East I West
Zone Classification
ft) Ur v L cs-
ZIP'1
Type Const.
Occupancy
Residential
Commercial D
Sprinklered
GYes CNo ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
7.
TO
TYPE /NEW ❑ ALT. ❑ AD' N.
OF ❑ BLD. ❑ PLMB.VMECH.
WORK
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ NoE:
Received Yes No[I1
Number
DESCRIBE WORK
$ 4t L-�l 2 4C_
VALUATION
9.
'c.412.NAE
SOURCE
OF
UTILITIES
GAS
T�r�� �`�C�v�•a
i'l
ELECTRIC WATER
PUBLIC ❑
PRIVATE C
Shorelines/Flood Hazard
Yes CI Not Apollo. O
SEWAGE
SEPTIC
SEWER 0
Ownership
Public F. Private C
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 VOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROV LS
PRELIM. FINAL DATE
APPLICATION'/ r Z
DATE f/ Q
Plans Required
Received !T
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Sr;}
1//
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
CC +v t L -
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)
LG £XD
TOTAL $ ' 4'�
PERMIT NUMBER
hcict
04*
* 19.00
* 19.006
*000
119.82
11-02-83
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 '4DATE4U
SdEEJ 2 — "
PERMIT11. 9' 9 oz
*19.00*O1rAL