1984, 03-13 Permit: 84A-2160 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT r=
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.
v.
STREET ADDRESS
LO BLOCK
D fhrr✓4atiid Nis
MAILING ADDRESS
PARCEL Nom.
SUBDIVISION
'71S-S6z
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North (South
CO TR
4. 7-\TO- f-elLnYIJ
ADD EEtS6V !
LENS EXPIRES
1
Size of Parcel
[East West
Zone Classification
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
P
E1:70 Com'
PHONE
Type Const.
Occupancy
Residential D
Commercial E
Spr'nklered
❑Yes ❑No Req 'd.
ZIP
TO
TYPE ❑ NEW XALT. ❑ AD' N.
7. OF ❑ BLD. APLMB. ❑ MECH.
WORK
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Cover Deck
Uncv. Deck
Fin. Basement
Greenhouse
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
YesE NoE
Yes No7
Number
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
Yes NotApplic. ❑
WATER
PUBLIC C
PRIVATE
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public E 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
REQUIRED IN% CTIONS
of construction. SEE REVERSE SIDE
SIGNATURE OF
OWNER OR AGENT
3! 3 �1-
APPLICATION
DATE �'�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required E
Received r
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
7Z272()
Other (Speci y) /C ig
TOTAL $ "
0=4.
r.
PERMIT IAUMBER
03* *3000
*30.006
A *Q00 8
215.9
03-13-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
_ 1
DATE ISSUEd >
PERMIZI1.6. 0 Z
*3 0.0 O aO,?AL