1984, 04-02 Permit: 84A-2801 Plumbing 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.
/3 r1/
5—L ‘,..t/
r
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
OWN
R"Wt
3 cvL "O
MAILING ADDRESS
rl
PHONE PHONE
%t
VC' /
ZIP
CONTRACTOR
4. AD___
LICENSE EXPIRES P O,ry E _
Actual Set Backs in Feet to:
North 'South
Size of Parcel
aT Y C 7rd': V / //Ur 4c -J
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
ZIP
tv `%
PHONE
Type Const.
Occupancy
ZIP
New Const. Valuation
East I West
Zone Classification
Residential L?
Commercial ■
Sprinklered
❑Yes GNo ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE '�( NEW ❑ ALT. ❑ AD' N.
7. OF
1�,
WORK BLD. X PLMB. 1=1MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
NO. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesE No I!
Received Yes No IT
Number
DESCRIBE WORK 7
�
8. (
VALUATION
9.
SOURCE GAS
UTILITIES
t Ac,..) L (
ELECTRIC WATER SEWAGE
PUBLIC 0 SEPTIC E
PRIVATE ❑ SEWER E
Shorelines/Flood Hazard
Yes, Not Applin. C
Ownership
Public 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. Alt 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 INS(.PECTIONS
SIGNATURE OF
OWNER OR AGENT �'G`'-' /7 r '
APPLICATION �/
DATE — / A `Y!
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SE PA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required G
Received .0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
4- 2-9ol
03*
*3800
*3800
*0.00 8
28002
04-02-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSU D
PERMI-QNG. B.1 5
*38.00gOAL