1984, 04-03 Permit: 84 A-2891 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.
STREET ADDRESS
Wi
BLOCK SUBDIV SUBDIVISION
5/),elft
2.
3
LOT
OWNS
ZA C_
MAILING ADDRESS
I'ARCi" L NO.
PHONE PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
East 1 West
CONT
4.
5.
OR LIC NSE EXPIRcS, PH E �/
%/ 7}, �i 5 /7Ol6,fc'
F7-9 � �i�f i s Z� 1,e, 7
DESIGNER PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Sprinklered
❑Yes ❑No CReq'd.
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPEEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7• OF
WORK ❑ BLD. ❑ PLMB.-ICi1ECH. E M.H. E POOL
❑ OTHER
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❑ NOC
Received Yes❑ No7
Number
8. I
ESC BE ORK
5-1:11
VALUATIO,r •URCE
9 LI
UTILITIES
Alcl di / "mu"r
ELECTRIC WATER
PUBLIC C
PRIVATE C
SEWAGE
SEPTIC 0
SEWER ❑
Shorelines/Flood Hazard
Yes Li NotApplic.
Ownership
Public 0 Private C
I hereby certify that I have read and examined this appl'cation 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 t. The granting of a permit does not presume to give au-
thority to violate or cancel the provisions of any oth= / ate or local law regulating construction or the performance
of construction. SEE REVERS ••' FOR REQU D INSPECTIONS
SIGNATURE OF /4W APPLICATION
OWNER OR AGENT — DATE
-17
SPECIAL APPROVALS SPECIAL CONDITIONS: SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam
Building
Tech.
i/;
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required C
Received C
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL c---�=��
PERMIT NUMBER
4A -2-S )
04* *31.50
*31,50
A *000
289.02
0.4-03-84
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIS5UEDJ 3 —d
PERMITa 9. 1 6
*31.50,.-,L