1984, 03-07 Permit: 84A-1934 Plumbing FixturesPLAN NUMBER
APPLICAT&N/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
LOT BLOCK SUBDIVISION
OWNER
3. S.'�U�f�crQ
MAILING ADDRESS
aULO LAN
PHONE
PHONE
Gtet
PARCEL NO.
LEGAL DESCRIPTION:
ZIP
CAZDei
Actual Set Backs in Feet to:
North !South East I West
CONTRACTOR
4.7:2-44-yr‘‘E`f ---PL_.:.yw\ i t.5(\
ADDRESS
-?v. •2_se)a-17
LICENSE EXPIRES
4444, 3166
PHONE
631:041j:2 -
Size
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Residential ❑
Commercial ❑
Sprinklered
❑Yes No OReq'd.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE New Const. Valuation
ZIP
TO
TYPE W NEW ❑ ALT. 0 AD' N. 0 RPL. 0 MVE.
7. OF
WORK ❑ BLD. E:54LMB. 0 MECH. ❑ M.H. ❑ POOL
0 OTHER
Remode ed Valuation
Total Bldg. Floor Area
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 Yea❑ No❑
Received Yes❑ No❑
Number
8 DESCRIBE WORK -cut cam--
4- KIK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard Plans Required ❑
Yes❑ Not Applic. C Received 9
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 REQ .a• ED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL
DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (S
3 Cd'.
1c_ ^JiL
I Lvgry O? -`-t
E La_ DiL&
:,z_ Sii�tutt2
REVERSE SIDE FOR NOTICE)
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 $
PERMIT NUMBER
*7400
*74.006
A *000
19335
03-07-84
0 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
fal DATE I&3E170 8 4
PERMIT ht.)?3 4 z
* 7 4. O OT 'AL