1983, 07-22 Permit: 83A-6866 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 8111 JEFF€RSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
eC/ G) o,,a14t
PARCEL NO.
LOT
BLOCK
SUBDIVISION
OWNER
3. �,� :e)f7„ /-
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
4.
5.
CONTRACTOR
ADDRESS
DESIGNER
ADDRESS
LICENSE EXPIRES
-
PHONE
5__-9pj5
ZIP����/;;--
Actual Set Backs in Feet to:
North (South
Size of Parcel
East ( West
Zone Classification
Type Const.
Occupancy
Residential El
Commercial 0
Sprinklered
❑Yea ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
6.
ZIP
TO
TYPE L NEW ❑ ALT. 0 AD' N. 0 RPL. ❑ MVE.
7. OF❑OTHER
0 BLD. C�,'PLMB. 0 MECH. 0 M.H. 0 POOL
WORK
W
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yea❑ No❑
Number
DESCRIBE WORK
8.
VALUATION
9.
Shorelines/Flood Hazard Plans Required ❑
Yes NotApplic. ❑ Received ❑
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
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
OWNER OR AGENT
SPECIAL APPROVALS
4OAPPLDATEICATIO.� j
t- /
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/- /i',i. S• � /- ,f% 74.4
f- �f� 'fr r
f.
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 $
5700
r
PERMIT NUMBER
03* *57.00
*57.008
A *000 8
68652
07-22-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'7-22-83 686.62 *57.00a�
DATE ISSUED PERMIT NO. TOTAL