1984, 01-26 Permit: 84A-731 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT-OF BUILDING & SAFETY g51A - 73'I
(7) NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADD SS PARCEL NO.
1. 7/C I4/eco' ro t- e.. 411
LOT BLOCKSUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
AICC,
3. MAILING ADDRESS ZIP Actual Set Backs in Feet to:
tt North (South East I West
4. CONTR OR/ / +. LIC,T EXPIRES PI-1-141 / Size of Parcel Zone Classification Residential❑
'16k-S Gltt� "!i . �Ij ,'it Commercial❑
:.-
A DDR 4, /, ZIP Type Const. Occupancy Sprinklered * 0 C
/ >i 7" ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area -A
5. -, ,_, ,-
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse -
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE a NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK 16 BLD. r� PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes CI No❑
DESCRIBE WORK / /J ) Shorelines/Flood Hazard Plans Required❑
8. 1 / l( (`Y� /1 �j1 y( S I Yes Not Applic.❑ Received ❑
VALUATION SOURCE] { GAS - ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9 PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER❑ public❑Private❑
UTILILITIES
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 Building
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 • • isions of any other state or local law regulating construction or the performance
of construction.SEE REVERS DE FOR • GUIRED INS• ` TIONS Plumbing
SIGNATURE OF �/ APPLICATION
OWNER OR AGENT %- t L '�- DATE / 2 ,� 8 Mech.
SPECIAL APPROVALS SPECIAL CONDIT ONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE _
Env.Health l' %c‘ _5 / /f`,' 1 SEPA
Planning ,— -6® _
/ II-// / Modular/
GCs / / /C MFG.Home >.
Engineer z3 Ilk
( .` ('/iU "` 1' Oher(Specify) J✓ ✓ 1 l
Utilities CC' Y'
,6j /.� �_
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
/���• PERMIT IS NONTRANSFERABLE
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ` IN 180 DAYS (�jj E 6 �i '77 3 1 0 * 7 o f
Tech. Z/ DATEISSUE� PERMIT N6. z 5 7. O 0 OPAL
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