1983, 05-10 Permit: 83A-3860 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
STREET ADDRESS
1. _5, 1Q 3c7 talo 017 EL( FP
PARCEL NO.
LOT BLOCK
2.
SUBDIVISION
OWNER Siol/1W //v/'9 — 5
3 (,e s Cd,4isra, c i i 01V
MAILING ADDRESS J y
CONTRACTOR
4. X/1400:'50A) -5 /S/7 ; `t, /YAC
ADDRESS
Z-• . 137 /a;' -kisp/ECD
PHONE
LICENS EXPIRES
9 el
PHONE
y.:2 oygy
ZIP
71.,2.,1
PHONE
q - 9?Lo
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South
East
lWest
Size of Parcel
Zone Classification
Residential
Commercial •
Type Const.
Occupancy
Sprinklered
❑Yes CNo CReq'd.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE E NEW ❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
7. OF C OTHER
WORK E BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ElPOOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes❑ No❑
YesC No—,
Number
DESCRIBE WORK
8. rQv) �ucT
VALUATION
9.
SOURCE
UTILLIITIES
may' eenr Pum!'
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE C
SEWAGE
SEPTIC C
SEWER "
Shorelines/Flood Hazard
Yes Not Applic.
Ownership
Public C Private E
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
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
DATE 5727/4
APPLICATION
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
P.. �A, , gro
rGEhiKssG '�
D
(-]
/Q . bQ
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required IE
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ Act)
PERMIT NUMBER
04* *1 ;,00
*19.00
*0,00
1
3859-
05-10-83
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IS 1 ED 10 -8 3
PERMIT N. 8 6.0
*19.0 4 AL