1983, 11-04 Permit: 83B-1287 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / W.SHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. S '37 CS—
LOT
2.
BLOCK
tt, t
SUBDIVISION
OWNER
3. 14 : fYi L'hl
ADDRESS
G. 3 _'S
CiSti
LEGAL DESCRIPTION — SEE ATTACHED
PHONE
a"� i77i
PARCEL NUMBER/S
ZI P
Actual Set Backs in Feet
North 'South (East 'West
4.
CRNTRACTORn
�1L 'YLatrvtelk,
A DINESS
PHONE
7 •7 Z.
Size of Parcel 1 Zone Classification
1 a: t.� �►
114 S ; C.3t4I >fl
ZI P
71;er y:
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor Upper Floors r Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
ENEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE N.
8.
VALUATION
9.
OL K
SOURC GAS
OF
UTILITIES
Enum. Dist.
Location (Area)
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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 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 INSPECTIONS
DATE OF APPLICATION 1 i ) 3 / �i 3
SIGNATURE OF APPLICANT �i� ►l,�l�
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
i S et S'A•.,
1" I)) Vnl
1— W 'A"5 Oiage.
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
65
PERMIT NUMBER
(13.
►z7
03* *6500
*65006
A *0.00 S
128.62
1-1 -04-83
2 6479,
WHEN MACHI ffVALIDATED IN THIS SPACE,
THIS BECOME A PERMIT.
1:1—*04�±^ET5'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
128.7z
PERMIT NO.
*65,00°1
TOTAL