1983, 07-05 Permit: 83A-6097 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY .0 - 6077
C----
NORTHp811 JEFFERSON /SPOKANE,WASHINGTON 99260/ (509)456-3675
/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. /3C,2< 3
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER. PHONE PHONE
Dr-A9 J 4.LL
er•
3. MAILING ADDRESS ZIP Actual Set Backs in Feet to:
North !South East I West
CONTRACTOR LIC NSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
4. .c9ee9 Se- ifire44mrr...44 -?y �lz 74-3Y 2� Commercial❑
ADDRESS ZIP / Type Const. Occupancy Sprinklered
13e2d3 ?Or ! �c,t,5. ,2( . DYes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5.
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
03 * * 45. 00
CHANGE OF USE FROM TO Cover Deck ' Uncv.Deck Fin.Basement Unf in.Basement
6. * 4 5.0 0 6
No.Baths No.Floors No.Fin.Rooms No.Dwellings A * G. 0 0 0
TYPE , .NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. I�LMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.ofExempt. Required YesE No❑ Number 6 0 9 6
or Variance Received Yes❑ No
07,- 05-83
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. /Q Fi+C-Tae 7.5 Yes❑ Not Applic.❑ Received ❑ ,5 6 4 7 9,
VALUATION SOURCE GAS ELECTRIC PUBLIC SEPTIC Ownership FEES COLLECTED
9 UTILITIES PRIVATE❑ SEWER❑ Public❑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 Building
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 -. other state or local law regulating construction or the performance g'5+t"'-
of construction.SEE REVERSE el FO' REQU •ED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION r� i
OWNER OR AGENT `I ` DATE / '� �� Mech.
—
SPECIAL APPROVALS SPECIAL CONDITI•NS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE -
Env.Health .2lcJ[�•
3°951 J SEPA
Planning I 7 '
Modular/
S 4064,4
Fire ( , MFG.Home
Prevent. 5 rve O
( C„° Other(Specify) W
Engineer ' J
Utilities Gt>�Sd Li
( Gc.)( TOTAL $ ��t
SEPA
MACHINE
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERM TTED IN THIS SPACE,
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildingWA IN 180 DAYS ((�� 77 z ((�� n n
Tech. �� DATEMUEDu 5 —8 / PERMITU 9, 7 5 * 4 5' 0 0�otAL